MCC, INC.MCC, INC.


MCC, INC. - APPLICATION FOR EMPLOYMENT
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disablity.
Position(s) Applied For: 
First Name: 
Middle Name: 
Last Name: 
Social Security Number: 
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List Your Addresses Of Residency For The Past 3 Years.
Current Street Address: 
Current City: 
Current State: 
Current Zip Code: 
Current Phone Number: 
How Long? 

Previous Street Address: 
Previous City: 
Previous State: 
Previous Zip: 
How Long? 

Previous Street Address: 
Previous City: 
Previous State: 
Previous Zip: 
How Long? 

Previous Street Address: 
Previous City: 
Previous State: 
Previous Zip: 
How Long? 
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Do You Have The Legal Right To Work In The United States? 
Date Of Birth: 
Can You Provide Proof Of Age? 
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Have You Worked For MCC, Inc. Before? 
If Yes, Please Fill Out The Following Information.
Where? 
Date Work Started At MCC, Inc.: 
Date Work Ended At MCC, Inc.: 
Rate Of Pay: 
Position: 
Reason For Leaving: 
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Are You Now Employed? 
If Not, How Long Since Leaving Last Employment? 
Who Referred You? 
Rate Of Pay Expected: 
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Is There Any Reason You Might Be Unable To Perform The Functions Of The Job For Which You Have Applied [As Described In The Job Description]?   
If Yes, Explain If You Wish: 
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EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle (includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding) in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.)

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 

Employer Name: 
Address: 
City: 
State: 
Zip: 
Contact Person 
Phone Number 
Month Work Started 
Year Work Started 
Month Work Ended 
Year Work Ended 
Position Held 
Salary / Wage 
Reason For Leaving 
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Accident Record for the past 3 years or more. If none, skip this section.

Last Accident Date: 
Nature of Accident (head-on, rear-end, upset, etc.): 
Fatalities: 
Injuries: 

Next Previous
Accident Date: 
Nature of Accident (head-on, rear-end, upset, etc.): 
Fatalities: 
Injuries: 

Next Previous
Accident Date: 
Nature of Accident (head-on, rear-end, upset, etc.): 
Fatalities: 
Injuries: 
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Traffic Convictions and Forfeitures for the past 3 years (other than parking violations).
If none, skip this section.

Location: 
Date: 
Charge: 
Penalty: 

Location: 
Date: 
Charge: 
Penalty: 

Location: 
Date: 
Charge: 
Penalty: 
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Highest Grade Completed: 
Last School Attended Name: 
Last School Attended City: 
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Driver Licenses

State: 
License Number: 
Type: 
Expiration Date: 

State: 
License Number: 
Type: 
Expiration Date: 
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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?   
If the answer to either of the previous questions is yes, please explain by giving details: 
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Driving Experience - Straight Truck. If none, skip this section.

Type of Equipment (Van, Tank, Flat etc.): 
Starting Date: 
Ending Date: 
Approximate Number of Miles (Total): 
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Driving Experience - Tractor and Semi-Trailer. If none, skip this section.

Type of Equipment (Van, Tank, Flat etc.): 
Starting Date: 
Ending Date: 
Approximate Number of Miles (Total): 
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Driving Experience - Tractor - Two Trailers. If none, skip this section.

Type of Equipment (Van, Tank, Flat etc.): 
Starting Date: 
Ending Date: 
Approximate Number of Miles (Total): 
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Driving Experience - Motorcoach - School Bus. If none, skip this section.

Type of Equipment (Van, Tank, Flat etc.): 
Starting Date: 
Ending Date: 
Approximate Number of Miles (Total): 
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Driving Experience - Other. If none, skip this section.

Type of Equipment (Van, Tank, Flat etc.): 
Starting Date: 
Ending Date: 
Approximate Number of Miles (Total): 
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List States Operated In For Last Five Years: 
Show Special Courses Or Training That Will Help You As A Driver: 
Which Safe Driving Awards Do You Hold And From Whom?: 
Show Any Trucking, Transportation Or Other Experience That May Help In Your Work For MCC, Inc.: 
List Courses And Training Other Than Shown Elsewhere In This Application: 
List Special Equipment Or Technical Materials You Can Work With (Other Than Those Already Shown): 
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THIS SECTION IS COMPLETELY VOLUNTARY

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental, or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.

Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations.
Referral Source   
Explain 
Name of person who referred you if applicable 

Sex   

Please select one of the following Equal Employment Opportunity Identification Groups:   
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By clicking the submit button, you agree to the following terms. This certifies that the application was completed by you, and that all entries on it and information in it are true and complete to the best of your knowledge. You authorize MCC, Inc. to make such investigations and inquiries of your personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) You hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with your application. In the event of employment, you understand that false or misleading information given in your application or interview(s) may result in discharge. You understand, also, that you are required to abide by all rules and regulations of MCC, Inc.

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