DRIVER EMPLOYMENT APPLICATION

DRIVER EMPLOYMENT APPLICATION
SIGNATURE 7 LLC

4786 AUSTIN STREET
SACRAMENTO, CA 95834
info@signature7.co
An Equal Opportunity Employer
COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED.
APPLICANT INFORMATION
Name

FIRST NAMEMIDDLE NAMELAST NAME
Phone Number

Area CodePhone Number
EMAIL
example@example.com
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SOCIAL SECURITY #
DATE OF APPLICATION

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
POSITION APPLIED FOR
DATE AVAILABLE FOR WORK

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have legal right to work in the United States?
PREVIOUS THREE YEARS RESIDENCY
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Number of years at this address
MAILING ADDRESS
- MAILING (if different from above)
- MAILING ADDRESS
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- PREVIOUS ADDRESS #1
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Number of Years at this address
- PREVIOUS ADDRESS #2
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Number of Year at this address
- PREVIOUS ADDRESS #3
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Number of Years at this address
- LICENSE INFORMATION
- No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21 I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.
- STATE OF ISSUE
- DRIVER'S LICENSE NUMBER
- TYPE/CLASS
- ENDORSEMENTS
- EXPIRATION DATE
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- DRIVING EXPERIENCE
- CLASS OF EQUIPMENT
- STRAIGHT TRUCK
  Type of Equipment (VAN, Tank, Flat, ETC...)
- Date From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Date To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx # of Miles Total
- TRACTOR & SEMI TRAILER
  Type of Equipment (VAN, Tank, Flat, ETC...)
- Date From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Date To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx # of Miles Total
- TRACTOR & 2 TRAILERS
  Type of Equipment (VAN, Tank, Flat, ETC...)
- Date From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Date To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx # of Miles Total
- TRACTOR & TANKER
- Date From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Date To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx # of Miles Total
- OTHER VEHICLE
  Type of Equipment (VAN, Tank, Flat, ETC...)
- Date From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Date To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx # of Miles Total
- ACCIDENT RECORD FOR THE PAST 3 YEARS
- CHECK THIS BOX IF NONE
- LIST MOVE RECENT FIRST
- Date of Accident 1
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- NATURE OF ACCIDENT 1
  (Head-on, rear-end, turn over, upset, etc...)
- # of Fatalities
- # of Injuries
- Chemical Spill (Y/N)
- Date of Accident 2
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- NATURE OF ACCIDENT 2
  (Head-on, rear-end, turn over, upset, etc...)
- # of Fatalities
- # of Injuries
- Chemical Spill (Y/N)
- Date of Accident 3
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- NATURE OF ACCIDENT 3
  (Head-on, rear-end, turn over, upset, etc...)
- # of Fatalities
- # of Injuries
- Chemical Spill (Y/N)
- TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)
- Check this box if none
- List most recent first
- Date of Convicted 1
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Type of Violation 1
  (DUI, Failure to Yield, Etc...)
- State of Conviction 1
- Penalty
  (Forfeited bond, Points, Citation, Suspended License, ETC...)
- Date of Conviction 2
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Type of Violation 2
- State of Conviction 2
- Penalty
  (Forfeited bond, Points, Citation, Suspended License, ETC...)
- Date of Conviction 3
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Type of Conviction 3
- State of Conviction 3
- Penalty
  (Forfeited bond, Points, Citation, Suspended License, ETC...)
- Date of Conviction 4
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Type of Violation 4
- State of Conviction 4
- Penalty
  (Forfeited bond, Points, Citation, Suspended License, ETC...)
- Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
- If yes, explain:
- Have you any license, permit, or privilege ever been suspended or revoked?
- If yes, explain:
- EMPLOYMENT HISTORY
- The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years. Any gaps in employment in excess of one (1) month must be explained.
  
  Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.
- CURRENT (MOST RECENT) EMPLOYER
- NAME
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone Number
  
  Area CodePhone Number
- POSITION HELD
- FROM MO/YR
- TO MO/YR
- REASON FOR LEAVING
- SALARY
- EXPLAIN GAPS IN EMPLOYMENT
  (included mo/yr & reason)
- While employed here, were you subject to the Federal Motor Carrier Safety Regulations? YES
- Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
- SECOND (MOST RECENT) EMPLOYER
- NAME
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- POSITION HELD
- FROM MO/YR
- TO MO/YR
- REASON FOR LEAVING
- SALARY
- EXPLAIN ANY GAPS IN EMPLOYMENT
  (Include mo/yr & reason)
- While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
- Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
- THIRD (MOST RECENT) EMPLOYER
- NAME
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- POSITION HELD
- FROM MO/YR
- TO MO/YR
- REASON FOR LEAVING
- SALARY
- EXPLAIN ANY GAPS IN EMPLOYMENT
  (Include mo/yr & reason)
- While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
- Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
- EDUCATION
- Name of High School
- City & State
- Course of Study
- Years Completed
- Did you graduate?
- Details
- Name of College
- City & State
- Course of Study
- Years Completed
- Did you graduate?
- DETAILS
- OTHER QUALIFICATIONS
  (Trade Schools, Certifications, or any other additional schooling)
- TO BE READ AND SIGNED BY APPLICANT
- I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.
- In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.
- - I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:
  - Review information provided by current/previous employers;
  - Have errors in the information corrected by previous employers, and for those previous employers to resend 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.
- This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.
- Applicant Signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Name
  
  First NameLast Name
- Should be Empty:

DRIVER EMPLOYMENT APPLICATION

APPLICANT INFORMATION

PREVIOUS THREE YEARS RESIDENCY

LICENSE INFORMATION

DRIVING EXPERIENCE

ACCIDENT RECORD FOR THE PAST 3 YEARS

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

EMPLOYMENT HISTORY

CURRENT (MOST RECENT) EMPLOYER

SECOND (MOST RECENT) EMPLOYER

THIRD (MOST RECENT) EMPLOYER

EDUCATION

TO BE READ AND SIGNED BY APPLICANT