Careers

Application



First Name *
Last Name *


Address *
City *
State *
v
Zip Code *
Email
Phone *
State Licensed
CDL


I, the undersigned, hereby authorize R & R Pipeline, Inc. or its insurance agency, Kernan Insurance Agency, Inc., or its assigns, to obtain copies of a motor vehicle report pertaining to me for employment purposes and for use in rating and/or underwriting insurance for which the above-named employer may apply, and any renewal thereof.


Last 4 digits of SSN *
Drivers License # *
Date of Birth *


Position Desired
Salary Desired
Date Available to Start
v

Are you currently employed?
If so, may we contact your present employer?
Have you ever applied to this company before?


Education History



High School


School Name
School Location
Major/Subject of Study
Did you graduate?


College


School Name
School Location
Major/Subject of Study
Did you graduate?


Trade School


School Name
School Location
Major/Subject of Study
Did you graduate?


Special skills or other items that may contribute to your abilities in performing the above mentioned position.


US Military or Naval Service?
Rank


Previous Experience

Start with most recent


Employer 1


Start Date
v
End Date
v
Company Name
Location
Role/Title
Reason for Leaving
Salary

Employer 2


Start Date
v
End Date
v
Company Name
Location
Role/Title
Reason for Leaving
Salary

Employer 3


Start Date
v
End Date
v
Company Name
Location
Role/Title
Reason for Leaving
Salary


References



List Three References


Name
Phone
Name
Phone
Name
Phone



Commercial Driver Experience and Qualifications



Straight Truck


Start Date
v
End Date
v
Equipment Type
Approx # of Miles

Tractor/Semi Trailer


Start Date
v
End Date
v
Equipment Type
Approx # of Miles

Tractor/Two Trailers


Start Date
v
End Date
v
Equipment Type
Approx # of Miles


Accident Record for Past 3 Years or More



Last Accident


Date
v
Nature of Accident
Fatalities
Injuries

Next Most Previous Accident


Date
v
Nature of Accident
Fatilities
Injuries

Next Most Previous Accident


Date
v
Nature of Accident
Fatailities
Injuries


Traffic Convictions and Forfeitures for Past 3 Years or More



Last Traffic Conviction/Forfeiture


Date
v
Locations
Charge
Penalty

Next Most Recent Traffic Conviction/Forfeiture


Date
v
Locations
Charge
Penalty

Next Most Recent Traffic Conviction/Forfeiture


Date
v
Locations
Charge
Penalty

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Has any license, permit or privilege ever been suspended or revoked?


Criminal Background Check Authorization



A criminal background check is required for employment. This check into official public records will determine the existence or non-existence of any record of criminal convictions. Federal and state law provides that certain positions of employment within the State of Ohio are unavailable to individuals who have plead guilty and or been convicted of criminal conduct, based on the nature of the criminal violations and/or the type of position being sought. Prior criminal convictions do not automatically preclude employment.

Full Name (Last, First, M.I.)

Previous Names Used Within 10 Years


Full Name
Date Changed
v
Full Name
Date Changed
v
Full Name
Date Changed
v

Date of Birth
v

Please provide complete addresses for U.S. residences during the last 10 years


Address 1


Start Date
v
End Date
v
Address
City
State
v
Zip

Address 2


Start Date
v
End Date
v
Address
City
State
v
Zip

Address 3


Start Date
v
End Date
v
Address
City
State
v
Zip

Address 4


Start Date
v
End Date
v
Address
City
State
v
Zip


Authorization



R&R Pipeline, Inc. maintains the right to conduct, either through state employees or through a third party, a criminal background check of any employee or job applicant. None of the information provided on this form will be used to discriminate against any applicant or employee on the basis of race, color, national origin, sex, sexual orientation, genetic information, religion, age, disability or military status.

By signing this form, you authorize R&R Pipeline, Inc. and/or it's designated third party to conduct a criminal background check. In addition, you acknowledge that any false or misleading statement, omission or failure to disclose information may disqualify you from employment or, if employed, may result in dismissal.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.

I authorize invesigation of all statements contained herein and the references and employers list above to give R & R Pipeline, Inc. any and all information concerning my previous employement and any pertinent information they may have; personal or otherwise. I release R & R Pipeline, Inc. from all liability for any damages that may result from utilization of such information.

I also understand and agree that no representative of R & R Pipeline, Inc. has any authority to enter into any agreement for employment for any specified time or to make any agreement contrary to the foregoing unless it is in writing and signed by an authorized company representative.

I hereby authorize R & R Pipeline, Inc. or it's insurance agency, Kernan Insurance Agency, Inc., or its assigns, to obtain copies of a motor vehicle report pertaining to me for employment purposes, and for use in rating and/or underwriting insurance for which R & R Pipeline, Inc. may apply and any renewal thereof.

Checking this box will act as your digital signature
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