Employment Application Form

If you need assistance with this application, or any phase of the employment process, please contact Certified Transmission at (402) 558-2117. If necessary we will attempt to accommodate your needs in a reasonable manner & time period. If a conditional offer is made, drug testing will be required as may other types of testing. Certified Transmission also utilizes random drug testing. If you want to review our drug/alchohol policy, please request a copy. Smoking is not permitted inside any company-owned facility.

Name & Address:

Have you resided in other counties in past 7 years?

Contact Information:
Job Information:

Available M-F 7:30am to 6pm?

Previously filed application with us?

Currently on "lay off" subject to recall?

Previously been employed with us?

Driving Information & Experience:


Do you have current valid driver license if required for employment?

Have you held a valid driver license in any other state(s)?

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Has any license, permit, or privilige ever been suspended or revoked?

Tractor & Trailer
Straight Truck
Tow Truck

Have you had any accidents - regardless of fault, within the past 3 years?

Have you had any traffic tickets or forfeitures / suspensions with the past 3 years?

Employment Experience:

Are you currently employed?

Previous employer(s)?

Provide the following information about any high school, college, or trade school attendance.

Felony conviction within past 7 years?

Certifications & Skills

Are you proficient in using a computer?

Please list any skills, apprenticeships, licenses or certificates that may be job-related or would have value for working at Certified Transmission, such as ASE, ATRA Certification, etc.

 Add Certification / Skill
Personal References

Certified Transmission requires two individuals that we may contact for a personal reference.

Comments / Questions:

Please describe any other skills, honors, and experience that may assist Certified Transmission in employment consideration.

Application Note:

Certified Transmission considers all applicants for all positions without regard, to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. A felony conviction will not necessarily bar an applicant from employment. This application form is intended for use in evaluation your qualifications for employment. This is not an employment contract and employment contracts and/or guarantees of employment are not made by Certified Transmission. Please answer all questions completely and accurately. False, misleading or incomplete statements during the interview and/or on this form and/or other employment related forms are grounds for terminating the application process or, if discovered after employment, and prior to reporting to work, you may be required to be examined by a medical professional, designated by Certified Transmission, depending upon the needs of the job, and will be required to complete a medical history form, and undergo testing for the presence of drugs in your body. Smoking is prohibited inside our facilities located in Nebraska, Iowa, Missouri, and Kansas.

Read & Agree to Application Note?


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