*field is required
Date of Birth*
CDL Driver's License #*
CDL Driver's License #/State*
Briefly describe your driving experience
Are you a citizen of the United States?*
I agree to the Application and Background Check Agreement
Read this Application Agreement carefully before submitting!
It is agreed and understood the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.
(GA & KS) - I understand that, as a condition of employment, I will obtain from the State Motor Vehicle Agency, within my probationary period, and without cost to the employer, a copy of my motor vehicle violations record.
(MA) - An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file with the commissioners of probation may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complain transferred to the superior court for criminal prosecution.
(MD) - An employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector, or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.
(PA) - I authorize my employer to obtain from the Registry of Motor Vehicles a copy of my Motor Vehicle Violations Records.
I understand that this application is not an employment contract and that, if hired, my employment and compensation can be terminated, with or without cause, at any time at the option of either the company or myself.
This certifies that all entries on this application are true and complete to the best of my knowledge.
Dac Services Tulsa, Oklahoma
In connection with my application for employment with you, I understand that an investigative consumer report is being requested from DAC Services, of Tulsa, Oklahoma, that will include information as to my character work habits performance, experience, along with reasons for termination of past employment from previous employers. Further, I understand that Keim TS, Inc. will be requesting information concerning my driving record and/or information from various federal, state, and other agencies which maintain record concerning traffic offenses, accidents, etc., as well as information from DAC Services, Tulsa,Oklahoma, concerning (1) previous driving record requests made by others from such state agencies;(2) state provided driving records;(3) claims including applicant in the files of insurance companies.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC SERVICES, of TULSA, OKLAHOMA, TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of the investigation. I hereby consent to Keim TS Inc. to obtain the above information from DAC SERVICES, of TULSA, OKLAHOMA, and agree that such information which DAC has or obtains, and my employment history with Keim TS Inc. if I am hired, will be supplied by DAC to other companies which subscribe to DAC's services.
Upon submitting, you have read, understood, and agree to terms of "Application Agreement".
All applicants must agree to our Drug & Alcohol guidelines to be considered for employment. Please read all requirements, acknowledge that you have read the form by signing it, and send to ADDRESS. Click here to download the the file in PDF form.