Contact Information for Employment

Diversified Transfer & Storage, Inc.
1640 Monad Road, Billings, MT 59101

I hereby certify that all information on this form is correct and complete to the best of my knowledge. I hereby authorize Diversified Transfer & Storage to do a complete background investigation in accordance with the state and federal laws. I authorize release of any information, including all information related to my alcohol and controlled substances testing and training records required by the Federal Highway Administration (FHWA) 49 CFR Parts 391 or 382, by any past or current employers. I hereby release all such persons from any liability or damages. I consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc., deemed necessary by DTS or its subsidiaries in their consideration of my employment.

Please answer all of the contact information fields, if a field is not applicable, please use N/A. Thank you.

Date: May 09,2008

Driver Position: Type of Driving Position:
Name: Date of Birth:
Social Security Number: Phone Number: Fax Number:
Address:
City: State: Zip:
Drivers License Number: Drivers License State: Endorsements:

E-Mail Address:
Are you 23 years Old or Older? Have you worked for this company before? If so when?:
Are You a US Citizen?: If, NO do you have Legal right to Work in the US?:
Have you ever tested positive or refused to test on any pre-employment Drug or Alcohol test administered by an employer to which you have applied for, but did not obtain employment during the past two years?
Current/Most Recent Employer Name: Phone Number:
Address:
City: State: Zip:
Are you presently employed? May we call your current employer?
Position Held: From: To:
Why do you want to change Employer:
Second Last Employer Name: Phone Number:
Address:
City: State: Zip:
Position Held: From: To:
Why did you change Employer?
Third Last Employer Name: Phone Number:
Address:
City: State: Zip:
Position Held: From: To:
Why did you change Employer?

Please give us some more details about your driving and equipment experience.

TO BE READ BY APPLICANT
Diversified Transfer & Storage, Inc. is an equal opportunity employer and does not discrimiate on the basis of sex, age, race and color, religion, marital status, national origin, disability or veteran status.

Additionally, Diversified Transfer & Storage, Inc. is a drug-free workplace and will be required to pass a pre-employment drug test. Understand that a positive pre-employment drug screen may result in refusal to hire.

It is agreed and understood that this contact form in no way obligates Diversified Transfer & Storage, Inc. to employ me.

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