1.FULL LEGAL NAME

2.DATE OF BIRTH

3.PHONE NUMBER

4.CURRENT ADDRESS

5.PRIOR ADDRESSES (last 5 years)

6.EMAIL ADDRESS

7.NEBRASKA DRIVERS LICENSE #

8.Have you been convicted of a felony or misdemeanor? 

Yes

No

9.Are you a U.S. citizen?

Yes

No

10.If you are not a U.S. citizen, are you authorized to work in the U.S.?

Yes

No

11.Have you engaged in sexual abuse in a prison, jail, lock-up community confinement facility, juvenile facility or other institution? Have you ever been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse? Have you been civilly or administratively adjudicated to have engaged in the activity described in the previous two questions? Have you ever resigned during a pending investigation of an allegation if sexual abuse or sexual harassment?

Can you answer yes to any of these questions?

No to all questions

12.If you accept employment, do you understand that you have a continuing duty to disclose any adverse contact with law enforcement or sexual misconduct throughout the duration of your employment?

Yes

No

13.Please list prior employers for the past 5 years. Name and Address

14.Disclaimer-I certify that my answers are true and complete to the best of my knowledge. By providing a PIN CODE and/ or submitting this application to Camelot Transportation Inc, you are providing permission for them to obtain background checks in order for employment. I understand false and misleading information on my application or interview may result in my release.

Create a 4 digit PIN 

Date