Step 1 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Applicant Information

Conditions of employment are stated at the end of this form. Please read carefully before you sign this
application. Application must be completed in full even if attaching a resume. Job applications are
considered active for 60 days after which the applicant must reapply for further consideration.

Previous Residence (last 3 years)

General Information

Step 2 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Employment History


Begin with your most recent employment and continue with all past employment for the last 3 years (attach additional sheets if necessary).Any employment that required driving will need to be provided for the last 10 years.




Step 3 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Education, Training and Certification

Other education after High School (most recent first):

Education Type of School Name of School, City, State Graduated Yes/No Earned Degree (AA,AS,AAS,BA,BS,Masters,PhD) Major or Course or Study
College
College
Graduate School
Business, Trade, Other

BUSINESS REFERENCES

  Number Issued By Expiration Date
Occupational,Certificate or Registration
Occupational,Certificate or Registration

Additional Experience or Qualifications

U.S. Military Information

References

Please list three professional references



Step 4 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Driver Licence Information

Driving Experience

Class of Equipment Type of Equipment (van, tank, flat, etc) Dates Approx # of Miles (Total)
Straight Truck
Tractor and Semi-Trailer
Tractor-TwoTrailer
Other

Traffic Convictions and Forfeitures (last three years)

Location Dates Charge Penalty

Accident Record (last three years)

Date Nature of Accident Fatalities Injuries Hazardous Material Spill

Step 5 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Notification And Agreement

PLEASE READ BEFORE SIGNING

I CERTIFY ALL ANSWERS GIVEN BY ME ARE, ACCURATE AND COMPLETE. I UNDERSTAND THAT THE FALSIFICATIO, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION(OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT ORIMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

Question regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opprtunity to all employees and applicants for employment without regard to age,race,religion,color,sex,national origin, martial status or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed any result in dismissal.

If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or Company medical examination or inquiry, including a drug-screening test. I consent to the investigation, physical and drug test.

I hereby authorize the Company to investigate all statements contained in this application, to interview the reference and previous employers listed in the application, and to obtain a report from a consumer reporting agency to be used for employment purpose in accordance with the Fair Credit Reporting Act. I authorize the references and previous employers listed to give the Comapny all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such information to the Company, including, but not limited to, any liablity or invasion of privacy.

If I am applying for a position as a Driver within any division of Hydrostatic LLC, I understand that information I provide regarding current and/or previous employers may be used, and those employers contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the comapny's option, this at-will employment policy applies except where prohibited by state or other applicable law, such as in the state of North Dakota. I also understand and agree that the terms and conditoins of my employment may be changed, with or without cause, and with or without notice, at any time by the comapny.

I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by the Company to submit to a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in immediate dismissal.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Step 6 of 7

APPLICATION FOR EMPLOYMENT - HYDROSTATIC

Authorization to Obtain a Consumer Credit Report and Release of Information for Employment Purposes

PLEASE READ BEFORE SIGNING

Pursuant to the Federal Fair Credit Reporting Act, I hereby authorize Hydrostatic LLC and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personal files; education;references;credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or country jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I,authorize the complete release of these records or data pertaining to me which an individual, company, firm,corporation or public agency may have. I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not effect any hiring decisions. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Hydrostatic LLC or its designated agents with any and all information in their possession regarding me in connections with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I hereby release Hydrostatic LLC and its agents, officials, representatives or assigned agencies, including officers, employees or related personal, both individually and collectively, from any and all liability for damages of whatever kind, which may at anytime result to me, my heirs, family or associates because of compliance with this authorization and request to release. I understand that a copy of this authorization may be give at any time, provided I do so in writing.

I understand that, pursuant to the Federal Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of theconsumer's right will be provided to me.

Step 7 of 7

FMCSA - Applicant Authorization to Release Safety Performance History

As required by 49 CFR parts 40.25 and 391.23

SECTION 1


TO BE COMPLETED BY PROSPECTIVE EMPLOYEE

Please complete highlighted section only

Print clearly

In accordance with section 391.23, we are obligated to requested the information below from all previous employers of the applicant that employed him/her to operate a commercial motor vihicle withinthe 3 years preceding the date above. Please complete the information below and return to us within 30 days, as required by section 391.23(g). Please phone/fax/mall the following information to:

SECTION 2


TO BE COMPLETED BY PREVIOUS EMPLOYER

EMPLOYMENT VERIFICATION




SECTION 3

TO BE COMPLETED BY PREVIOUS EMPLOYER

ACCIDENT HISTORY


Date Location No. of Injuries No. of Faralities Hazmat Spill
Please provide information concerning any other commercial motor vehicle accidents involving the applicant that were reported to government agencies or insurers or retrained internal company under company polocies:


SECTION 4

TO BE COMPLETED BY PREVIOUS EMPLOYER

DRUG AND ALCOHOL HISTORY


If applicant was not subject to DOT testing requirements under 49 CFR Part 40 while employed by you, please check here and return.

In answering these questions, include any required DOT drug or alcohol testing information from other employers in the 3 years prior to the application date shown on SIDE1.

Withing the past 3 year from the application date on SIDE1:
Has this person violated any of the drug and/or alcohol probhitions under 49 CFR Part 40 or Subpart B of Part 382,including:

SECTION 5


TO BE COMPLETED BY PROSPECTIVE EMPLOYERS


SECTION 6


TO BE COMPLETED BY PROSPECTIVE EMPLOYERS