All Required Fields In Red Must be Completed
Personal Information
First Name:  
Middle Initial:
Last Name:  
Street Address:  
City:  
State:  
Zip:    
Home Phone:    
Cell Phone:  
Email:  
SSN:  
Date Of Birth: /   /    
License Information
CDL Number:  
CDL State:  

Previous CDL #:
CDL State:

Endorsements
Hazmat:
Doubles\Triples:
Tank:
Passenger:

Other
Twic Card:
Background Information
Number of preventable accidents in the last 3 years?  
Number of moving violations in the last 3 years?  
Have you ever had any DUI's/DWI's?  
Have you ever been charged or convicted of a felony?  
If "Yes" please explain in the additonal comments section.
Preferences
When would you be available to start:  
Select the company you are applying to:  
(If applying with Service transport) I would like to run...
Solo
Team
Husband/Wife Team
Owner Operators
Do you own a tractor?
Tractor Make:
Tractor Year:
Tractor Weight:
Mileage:
Experience
Amount Of OTR Experience  
Employment History (10 Years History Required)
Last or Current Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Prior Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Prior Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Prior Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Prior Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Prior Employer
Company:
City: State:
Phone:
Title:
Employed From: / To: /
Reason For Leaving:
Additional Comments

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation in this application is sufficient cause for refusal to hire or dismissal if I have been hired regardless of date of discovery by Adams Resources & Energy, Inc. and its subsidiaries (the Company). I authorize the company to thoroughly investigate all statements contained in this application or resume, and I authorize my former employers to disclose information regarding my former employment, character and general reputation with them to the Company without giving me prior notice to such disclosure. In addition, I release the Company and any former employers from any claims, demands, or liabilities arising out of or related to such investigation and/or disclosure. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create any employment contract. I further understand and agree that if I am hired any employment will be “AT WILL” and without fixed term and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Company unless made in writing. I understand that completion of this application does not indicate employment availability and does not obligate the Company to hire me. I agree to adhere to all Company work rules, policies and procedures. Adams Resources & Energy, Inc. and its subsidiaries reserve the right to revise its policies or procedures, in whole or in part at any time.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Company uses any information it obtains from a consumer reporting agency, including FMCSA, in a decision to not hire you or to make any other adverse employment decision regarding you, the Company must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from a consumer reporting agency; the name, address, and the toll free telephone number of consumer reporting agency; that the consumer reporting agency did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the consumer reporting agency the accuracy or completeness of any information or report. If you request a copy of any consumer report from the Company who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Company must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Adams Resources & Energy, Inc. and its subsidiaries does not discriminate in hiring or employment on the basis of race, color, creed, national origin, sex, age, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam Era, or any basis prohibited by state or federal law. No question on your application is intended to secure information used for such discrimination. All applicants and employees will be treated equally in conformity with all existing laws.

HIRERIGHT, INC. AUTHORIZATION

I understand that Adams Resources & Energy, Inc. and subsidiaries (the Company) may request, for lawful purposes, background information about me from a consumer reporting agency, i.e., Hire Right, Inc., in connection with my employment or application for employment. This information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as “background reports”). These background reports may be obtained at any time after receipt of your authorize and, if you are hired, or engaged by the Company, throughout your employment or your contract period.

The background reports may contain information concerning my character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker’s compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional reference checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.

This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; personal interviews with sources such as neighbors, friends and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated.

I consent to the preparation of background reports by a consumer reporting agency such as HireRight, Inc. and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or contract period.

I understand that the information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me.

PSP AUTHORIZATION

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.

I understand Adams Resources & Energy, Inc. and subsidiaries (the Company) may obtain one or more reports regarding my driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). I authorize the Company to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Company to make a determination regarding my suitability as an employee.

I further understand that neither the Company nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand that I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND BY MY ELECTRONIC SIGNATURE BELOW INDICATE MY ACCEPTANCE OF THIS AGREEMENT AND AUTHORIZE ANY BACKGROUND REPORTS THAT MAY BE REQUESTED BY OR ON BEHALF OF THE COMPANY.

Electronic Signature: X   (Type your full name)