(Contracted Service Provider for FedEx Ground)

Employment Application Form

Contact Details

Full Legal Name:    E-Mail:

Phone:            2nd Phone:
Phone Type:                        Phone Type:

Emergency Contact Name:    Relation to candidate:
Contact Phone:    Contact Country:
Emergency Contact's Address, City, State & Zip:

Preferred Name (for badging):

Personal Information

Date of Birth:    SSN#/SIN#    Position Sought:
Desired Start Date:    Are you eligible to lawfully work in the United States/Canada?   
Are you over 18 years of age?     Are you presently employed or under contract?  
Do you have a former name?      If yes, former name:

Have you ever been discharged from a place of employment or a contract?  
If yes, brief explanation...

How many days were you absent in the last two years?
(Do not include military, vacation, medical leave, funeral, jury duty or any other absence protected by law)
Your comment, if any...

May we contact your present and past employers?   
NOTE: Federal Motor Carrier Safety Regulations require FedEx Ground / FedEx Home Delivery to make inquiries to each of your past employers
Do you have a current Department of Transportation (DOT) Physical?      If yes, complete the following:
Date:    Did you qualify?   
Physician Name:    Country:
Physician's Address, City, State & Zip:


References (Please enter three personal references not including relatives or persons identified in the previous employment section of this sheet)

1st Reference's Name:
Occupation:    Phone:
Address, City, State & Zip:


2nd Reference's Name:
Occupation:    Phone:
Address, City, State & Zip:


3rd Reference's Name:
Occupation:    Phone:
Address, City, State & Zip:


Address History (Please enter all addresses where you have lived in the last three (3) years, including your present address)

1. Address, City, State & Zip:

From:    To:

2. Address, City, State & Zip:

From:    To:

3. Address, City, State & Zip:

From:    To:

4. Address, City, State & Zip:

From:    To:

Driving Experience

Do you currently have driving experience?      If yes, please complete all following details.
Vehicle type:    Fuel type:    State Driven: Yrs./Mos.

Vehicle type:    Fuel type:    State Driven: Yrs./Mos.

Licenses and Permits (List all personal and commercial motor vehicle operator's licenses issued in the past three (3) years)

1. Current License?      License Type:    License Number:
Country:    State:    Date issued:    Date expires:
Have you EVER had this motor vehicle license denied, revoked or suspended?
If yes, enter details - (List date, Type, how long and reason)


2. Current License?      License Type:    License Number:
Country:    State:    Date issued:    Date expires:
Have you EVER had this motor vehicle license denied, revoked or suspended?
If yes, enter details - (List date, Type, how long and reason)


Education

Country:    School Type:    Month/Year Started:
Month/Year Finished:    Graduated?    School Name:
State:    Degree:    Major:

Legal History

Have you ever been convicted or plead guilty to felony under your present or any other name?  
Comments (If yes, enter Date, State and Charge Convicted of):


Have you ever been convicted or plead guilty to misdemeanor under your present or any other name?  
Comments (If yes, enter Date, State and Charge Convicted of):


Do you have any criminal matters pending under your present or any other name?  
Comments (If yes, enter Date, State and Charge Convicted of):


FedEx History

Have you ever applied at or been employed or contracted by a FedEx Ground affiliate company under your present name or any other name?     If yes, please complete the following:  Prior FedEx Status:  
Was current name used at time of Application / Employment / Contract?   
If No, please enter the full name:
Position Held / Applied for:    Location:
If previously employed/contracted by FedEx Ground, complete the following
Start Date:    End Date:    Reason for leaving:

FedEx Contacts / Relatives

Contacts:
Do you know anyone employed or contracted by a FedEx Ground affiliate company?  
Contact's Name:
Occupation:    Position:    Location/Company:
Phone:    Relationship:

Relatives:
Are you related to anyone employed or contracted by a FedEx Ground affiliate company?  
Relative's Name:
Occupation:    Position:    Location/Company:
Phone:    Relationship:

Employment History List present and ALL previous employment in the past three (3) years. CDL must list prior ten (10) years with no gaps by entering any necessary details. Start with present and work back. To indicate periods of Unemployment please fill in a section citing the appropriate time frame, and entering "Unemployed" in all required fields and keeping the Ending Pay Rate equal to 0.

1. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


2. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


3. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


4. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


5. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


6. Start date of employment:    End date of employment:
Employer:    Phone:
Employer Address, City, State & Zip:

Ending Job Title:    Relevant Work Experience:  
Ending Pay Rate:    Pay Rate Frequency:    Business Type:
Supervisor Name:    Number of people supervised:
Current Status:
Comments:


Driving Violations

Have you ever been convicted of or forfeited bond for violation of motor vehicle laws or ordinances other than parking during the past three (3) years, or do you have any pending matters relating to motor vehicle laws or ordinances?
If yes, enter the following for each violation:

1. Date of violation:    Nature of Violation:  (if speeding, indicate rate of speed)
Vehicle Type:     Country:    State:    Penalty:    Points:

2. Date of violation:    Nature of Violation:  (if speeding, indicate rate of speed)
Vehicle Type:     Country:    State:    Penalty:    Points:

Accidents

Have you ever been involved in ANY motor vehicle accidents in the past three (3) years?
If yes, complete the following:
Date of Accident:    Nature of Accident:
Describe Extent of Damage / Injuries (including monetary value if applicable):

Number of deaths:    Number of injuries:    Vehicle Type:   On/Off Road:  
At Fault:


I, your name will be inserted here , in connection with this service, authorize all corporations, companies, credit agencies, educational institutions, law enforcement agencies, military services, former employees and individuals to release information they may have about me to FedEx Ground and their agents, and release them from any liability or responsibility for doing so. I further authorize the procurement of an investigative consumer report and understand that such a report may contain information about my background, character, and personal reputation and that further information may be available upon written request within a reasonable period of time.

I understand this notice will also apply to any future report updates that may be requested.

I also certify that this Information Form was completed by me and that all entries and information in it are true and complete to the best of my knowledge. I signify this by selecting "Yes" for the following option box *

If you select anything other than Yes, your application will NOT be submitted and
ALL DATA ENTERED WILL BE LOST!

*Mandatory field