Complete the Online Employment application below and press the SUBMIT button.

UniGroup, Inc.

Van Operator: Check Appropriate Carrier (Check only one carrier)

United Van Lines, Inc., One United Drive, Fenton, MO 63026 (636-326-3100)
Mayflower Transit, Inc., One Mayflower Drive, Fenton, MO 63026 (636-305-4000)

VAN OPERATOR APPLICATION FOR QUALIFICATION
Information Required by U.S. Department of Transportation of Van Operators
Co-Van Operators before being considered for qualification
Date:
Continental Fleet Master Lease Co-Van Operator Contract Truckman Household Goods Special Services
AGENCY # NAME LOCATION
P E R S O N A L
Name (Last) Name (First) Name (Middle) Date of Birth Social Security No.
Address (Street) (City) (State) (Zip) How Long? Telephone No. - -
List additional addresses within last 5 years:
How Long?
How Long?
How Long?

Are you legally eligible to work in the United States? Yes No
Visa Number
PERSON TO NOTIFY IN CASE OF EMERGENCY    Name: Phone Number:
For purpose of verifying past employment, have you been previously known by any other names? Yes No If yes, identify name(s):

Can you read, write and speak the English language? Yes No
Have you ever been convicted of a felony or misdameanor, or released from prison in the past 10 years? Yes No If yes, please explain fully:
When?
Are you charged with an unresolved criminal charge (have you been charged with a crime that has not yet resulted in a plea of guilty, court trial or a dropping of the charge or on legal probation? Yes No
If yes, please explain fully:
Do you meet the required minimum qualifications and with or without reasonable accommodation are you able to perform the essential functions of the position for which you are applying? Yes No
If no, please explain:  
Within the preceding two (2) years, have you refused submission to or tested positive to a D.O.T. required drug or alcohol test? Yes No
EDUCATION Indicate Highest Grade Completed:
J O B .... H I S T O R Y
 MILITARY SERVICE Yes No If yes, indicate branch, dates, type of discharge and rank

Begin with present or most recent job (explain any gap). Applicant needs to show 10 years of job history.
Name: Address: Phone#: From (MMYY) To (MMYY) Position: Supervisor: Reason for Leaving:
Name: Address: Phone#: From (MMYY) To (MMYY) Position: Supervisor: Reason for Leaving:
Name: Address: Phone#: From (MMYY) To (MMYY) Position: Supervisor: Reason for Leaving:
Name: Address: Phone#: From (MMYY) To (MMYY) Position: Supervisor: Reason for Leaving:
Have you been qualified with any UniGroup company before? Yes Agency Name: When: Any other household goods carriers? Yes. If yes, carrier's name
EXPERIENCE HISTORY:

 
LOCAL OPERATION:
From mm/yy
To mm/yy
Loading/Unloading Household Goods
Loading/Unloading Electronic Equipment
Loading/Unloading Special Commodities
Driving Straight Truck
Driving Tractor/Trailer Unit
Other
 
 
OVER THE ROAD : From mm/yy To mm/yy
Loading/Unloading Household Goods
Loading/Unloading Electronic Equipment
Loading/Unloading Special Commodities
Driving Straight Truck
Driving Tractor/Trailer Unit
Other

QUALIFICATION - VAN OPERATOR
CURRENT COMMERCIAL DRIVERS LICENSE (CDL) List previous licenses held in last three years
IISSUING STATE                     CDL NUMBER                             CLASS                    EXPIRATION DATE




Any restrictions on your present license? Yes No     If yes, describe
Has a denial, revocation, or suspension of any license, permit, or privilege to operate a motor vehicle ever been issued to you? Yes No
If yes, give details
Have you ever been convicted or forfeited bond for driving while under the influence of alcohol or a controlled substance or public intoxication? Yes No
If Yes, give details
ACCIDENT HISTORY
LOCATION (City & State)       Date                       Nature of Accident                     TYPE OF VEHICLE               No. Injuries  No. Fatalities   




TRAFFIC VIOLATIONS
List all violations of Motor Vehicle Laws or Ordinances (other than parking) of which you have been convicted or forfeited bond during the last 3 years. If None, please check None
LOCATION



CERTIFICATION - RELEASE
To be read and signed by applicant

I understand that if I am qualified, any misrepresentation or omission of a material fact on this application for qualification or during an interview, if any, may be cause for disqualification at any time. The carrier may verify the information which I have provided in the course of its consideration of this application for qualification.

I additionally authorize the UniGroup Company or its designated agents to conduct a thorough investigation of my past employment, education, criminal history, references, and activities, as needed to determine my qualifications and eligibility to occupy a position to perform safety sensitive functions. I authorize all persons who may have information relative to this investigation to disclose such information to the carrier or its agents. This specifically includes the release of information by my present and former employers, law enforcement agencies, courts, criminal justice agencies, educational institutions, financial institutions, military records, landlords, creditors and others, whether or not specifically mentioned herein. I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which I may incur at any time arising out of or in any way related to attempts to comply with this authorization.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge and belief.

I certify that I am a genuine applicant for a van operator position and this application is being submitted solely for the purpose of seeking qualification with the carrier and for no other reason.

Applicant's Signature Date
e-Mail Address: