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505 S. Pearl St., Janesville, WI 53545

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License Number: US DOT 498128 WI

Cash & Carry Discounts Available

All Fuel Deliveries Have A 150 Gallon Minimum

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Home
Fuels
Diesel Exhaust Fluid (DEF)
Biodiesel
Lubricants
Bulk Window Washer
Employment
Contact us
- Service Area
  - Beloit
  - Evansville
  - Milton
  - Clinton
  - Edgerton
  - Brodhead
  - Orfordville
  - Delavan
  - Burlington
  - Elkhorn
  - Darien
  - Whitewater
  - East Troy
  - Fort Atkinson
  - Walworth
  - Fontana
  - Williams Bay
  - Lake Geneva
  - Madison
  - Monona
  - Fitchburg
  - Stoughton
  - Oregon
  - McFarland
  - Cottage Grove
  - Sun Prairie
  - Middleton
  - Jefferson

Employment Application

We are accepting applications

First Name:

Middle Name:

Last Name:

Date of Birth

Social Security #:

Phone:

Email:

Address:

City:

State:

Zip Code:

Addresses for the Past Three Years

Address 1:

City:

State:

Zip Code:

Address 2:

City:

State:

Zip Code:

Do you have the legal right to work in the United States?

Yes

Can you provide proof of age?

Yes

Have you worked for Brown Oil Co. before?

Yes

If Yes, where?

Dates Previously Employed:

From:

To:

Rate of Pay?

Position You Held?

Reason For Leaving?

Are You Now Employed?

Yes

If not, how long since last employment?

Who Referred You?

Rate of Pay Expected?

Is there any reason you might know of that might inhibit you from performing the tasks related to the position for which you have applied for?

Yes

If yes, please explain based on what you understand those tasks are.

Employment History

All driver applicants to drive interstate commerce must provide the following information on all employers during the preceeding 3 years.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years of information on the employers for whom the applicant operated such vehicle.

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Employer 1

Employer Name:

Address:

City:

State:

Zip Code:

Contact Name:

Contact Phone Number:

Were you subject to the FMCSRs in this position while employed by this previous employer?

Yes

391.21(b)(10)(iv)(A)

Employed From:

Employed To:

Position Held:

Salary/Wage:

Reason for Leaving:

Was this position designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing?

Yes

391.21(b)(10)(iv)(B)

Employer 2

Employer Name:

Address

City:

State:

Zip Code:

Contact Name:

Contact Phone Number:

Were you subject to the FMCSRs in this position while employed by this previous employer?

Yes

391.21(b)(10)(iv)(A)

Employed From:

Employed To:

Position Held:

Salary/Wage:

Reason for Leaving:

Was this position designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing?

Yes

391.21(b)(10)(iv)(B)

Employer 3

Employer Name:

Address:

City:

State:

Zip Code:

Contact Name:

Contact Phone Number:

Were you subject to the FMCSRs in this position while employed by this previous employer?

Yes

391.21(b)(10)(iv)(A)

Employed From:

Employed To:

Position Held:

Salary/Wage:

Reason for Leaving:

Was this position designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing?

Yes

391.21(b)(10)(iv)(B)

Employer 4

Employer Name:

Address:

City:

State:

Zip Code:

Contact Name:

Contact Phone Number:

Were you subject to the FMCSRs in this position while employed by this previous employer?

Yes

391.21(b)(10)(iv)(A)

Employed From:

Employed To:

Position Held:

Salary/Wage:

Reason for Leaving:

Was this position designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing?

Yes

391.21(b)(10)(iv)(B)

Employer 5

Employer Name:

Address:

City:

State:

Zip Code:

Contact Name:

Contact Phone Number:

Were you subject to the FMCSRs in this position while employed by this previous employer?

Yes

391.21(b)(10)(iv)(A)

Employed From:

Employed To:

Position Held:

Salary/Wage:

Reason for Leaving:

Was this position designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing?

Yes

391.21(b)(10)(iv)(B)

Experience and Qualifications - Non-Driver Applicants

Accident record for past 3 years or more (Attach sheet if more space is needed)

Accident 1

Date:

Nature of Accident:

Fatalities:

Injuries:

Accident 2

Date:

Nature of Accident:

Fatalities:

Injuries:

Accident Record

Upload File

Free Text

Traffic convictions and forfeitures for the past 3 years (other than parking violations)

Location:

Date:

Charge:

Penalty:

Location:

Date:

Charge:

Penalty:

Free Text

Attach sheet if more space is needed

Traffic Convictions

Upload File

Education

Highest Grade Completed:

Last School Attended:

Location:

Experience and Qualifications - Driver Applicants

Driver Licenses:

State:

License #:

Type:

Expiration Date:

Driver License 2

State:

License #:

Type:

Expiration Date:

Driver License 3

State:

License #:

Type:

Expiration Date:

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

Yes

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

Yes

If the answer to any of the above is yes, attach statement giving details

License Denial Details

Upload File

Driving Experience

If none, write NONE

Straight Truck

Type of Equipment (Van, Tank, Flat, Etc.)

Date From:

Date To:

Approx. No. of Miles (Total)

Tractor-Trailer

Type of Equipment (Van, Tank, Flat, Etc.)

Date From:

Date To:

Approx. No. of Miles (Total)

Doubles/Triples

Type of Equipment (Van, Tank, Flat, Etc.)

Date From:

Date To:

Approx. No. of Miles (Total)

Other Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Date From:

Date To:

Approx. No. of Miles (Total)

List state you operated in for the last five years:

List special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom:

List any trucking, transportation or other experience that may help in your work for this company:

List courses and training other than that shown elsewhere in this application:

To be read by applicant before submitting

Sec. 40.25(j)

As the employer, you must also ask the employee whether he or she has tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety sensitive functions for you until and unless the employee documents successful completion of the return-to-duty process. (see Sec. 40.25 (b)(5) and (e).

The prosepctive employee is required by Sec. 40.25(j) to respond to the following questions.

Have you ever tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?

Yes

If you answered yes, can you provide/obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes

Submitting this form certifies that I completed this application, and that all entries and information documented by me are true and complete to the best of my knowledge. By submitting heretofore, I acknowledge having been given by this carrier which has presented me with this application, a statement of my right to due process as outlined by all parts of 49 CFR Part 391.23 of the Federal Motor Carrier Safety Regulations effective October 29, 2004. Having made this acknowledgment, I therefore authorize you to make such previous employment and background investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary to arrive at a possible employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I understand that false or misleading information given in my application or interviews may result in discharge. I understand also, that I am required to abide by all rules and regulations of the company.

Thank you for contacting us.
We will get back to you as soon as possible.

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Location

505 S. Pearl St.

Janesville, WI 53545

Email

jim@brownoilco.com

Call

608-752-7696

Fax

608-754-5301

Home
Fuels
Diesel Exhaust Fluid (DEF)
Biodiesel
Lubricants
Bulk Window Washer
Employment
Contact us
- Service Area
  - Beloit
  - Evansville
  - Milton
  - Clinton
  - Edgerton
  - Brodhead
  - Orfordville
  - Delavan
  - Burlington
  - Elkhorn
  - Darien
  - Whitewater
  - East Troy
  - Fort Atkinson
  - Walworth
  - Fontana
  - Williams Bay
  - Lake Geneva
  - Madison
  - Monona
  - Fitchburg
  - Stoughton
  - Oregon
  - McFarland
  - Cottage Grove
  - Sun Prairie
  - Middleton
  - Jefferson

The region's leading fuel and lubricant distributor

Office hours

Mon - Fri: 9:00 am - 5:00 pm
Sat - Sun: Closed

Order taking hours

Mon - Sun: Open 24 Hours

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Pay Invoice Now