Black & White Transportation

Last Name

First Name

Primary Phone

Email Address

Have you ever been convicted of a felony?

Are you at least 25 years old?

How did you hear about us?

Please read:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I understand that my employment is contingent on being accepted by the insurance company based on my 3 year Motor Vehicle Report. I will not be eligible to drive if my record has 4 points or more, or if there are any DUI convictions. I authorize the company to run my report to determine my eligibility to be insured. To maintain my position, I agree to maintain a record of less than 4 points.

I authorize my previous employers, schools, or persons provided as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

Full Name/Signature

Driver's License/State ID Number

(In lieu of a signature, please enter your driver's license or state issued ID number in the box above to signify that you agree to the statements above.)