Truck Driver Application

BRUNTON MOTOR FREIGHT DRIVER APPLICATION

Please give complete answers to ALL questions - Incomplete answers will only slow, or stall the application and our goal is to get you hired quickly.

Thank you Drivers, You move America forward - No matter WHO you drive for!
You are applying for a Class A CDL driving position with Brunton Motor Freight Inc, P.O. Box 401, 18862 N 1600 East Rd, Pontiac, IL 61764. Thank you for showing interest in our company. We hope to be a part of your next career path.
Today's Date*

MonthDayYear
Date
Position Applying for*

LocalRegionalOTROther
General Information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
E-mail*
Are you at least 23 years of age or older with 3 years of similar driving experience?*

YesNo
License Information
Have you held a VALID US license for the past 36 months?*

YesNo
License Class*
License Number*
State of Issue*
License expiration date*

MonthDayYear
Expiration date of DOT physical card

MonthDayYear
CDL Endorsements*

NoneTankerDoubles/TriplesHazmatX EndorsementTWIC
Were you ever in the military?*

YesNo
Branch of service
Please list Dates of enlisment
Enlist date - Discharge date
Did you receive an honorable discharge?

YesNoOther
Have you been to truck driving school?*

YesNo
School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry
Did you graduate?

YesNo
List any special courses/training completed.
List any safe driving awards you hold,date awarded & from whom:
EMPLOYMENT HISTORY
Work History: Please list current, or most recent employment first
Start date*

MonthDayYear
Ending date*

MonthDayYear
Employer Name*
City, State*
Employer phone*

Area CodePhone Number
Position Held*
Reason for leaving*
Is this your current employer?*

YesNo
May we contact this employer at this time?*

YesNo
Was this a driving position?*

YesNo
Were you subject to the FMCSRs while employed here?*

YesNo
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

YesNo
Type of truck
Type of trailer
Trailer length
Number of states driven
Number of Miles Driven
NEXT EMPLOYER
Start date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Position Held
Reason for leaving
Employer phone

Area CodePhone Number
Was this a driving position?

YesNo
Were you subject to the FMCSRs while employed here?

YesNo
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

YesNo
Type of truck
Type of trailer
Trailer length
Number of states driven
Number of miles driven
NEXT EMPLOYER
Starting date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Position Held
Employer phone

Area CodePhone Number
Reason for leaving
Was this a driving position

YesNo
Were you subject to the FMCSRs while employed here?

YesNo
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

YesNo
Type of truck driven
Type of trailer
Trailer length
Number of states driven
Number of miles driven
NEXT EMPLOYER
Start Date

MonthDayYear
End Date

MonthDayYear
Employer Name
City and State
Position
Employer Phone

Area CodePhone Number
Reason for leaving
Was this a driving position

YesNo
Were you subject to the FMCSRs while employed here?

YesNo
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

YesNo
Type of truck driven
Type of trailer
Trailer length
Number of states driven
Number of miles driven
If you need additional space for past employment, please enter it here and include ALL information previously asked for.
Moving Violations/Accidents
Have you had any moving violations in the last 5 years?*

YesNo
Violation 1 Date

MonthDayYear
Date
Please list City, State,and nature of offense and any fines involved
Please list miles over limit for speeding
Violation 2 Date

MonthDayYear
Date
Please list City, State,and nature of offense and any fines involved
Please list miles over limit for speeding
Violation 3 Date

MonthDayYear
Date
Please list City, State,and nature of offense and any fines involved
Please list miles over limit for speeding
Please list any additional moving violations including date, City, State,and nature of offense and any fines involved
Please list miles over limit for speeding
Has your license suspended ever been suspended?*

YesNo
If yes, please give date and length of supension. List reason why, city, county and state
List all details asked for
Have you had any accidents in the last 5 years?*

YesNo
Accident Record for the Past 5 Years
Accident 1 Date

MonthDayYear
Date
Please list nature of accident, city, state, etc.
Did you receive a ticket for this accident?

YesNo
if any, # of vehicles towed from the scene of the accident.
if any, # of people transported from scene for injuries.
if any, # of fatalities
Accident Record for the Past 5 Years
Accident 2 Date

MonthDayYear
Date
Please list nature of accident, city, state, etc.
Did you receive a ticket for this accident?

YesNo
if any, # of vehicles towed from the scene of the accident.
if any, # of people transported from scene for injuries.
if any, # of fatalities
Accident Record for the Past 5 Years
Accident 3 Date

MonthDayYear
Date
Please list nature of accident, city, state, etc.
Did you receive a ticket for this accident?

YesNo
if any, # of vehicles towed from the scene of the accident.
if any, # of people transported from scene for injuries.
if any, # of fatalities
Have you ever had a DUI, DWI, or OVI?*

YesNo
If yes, please list date of offense, jail time, fine and or suspension time.
We must have complete information to satisfy isusance carrier requirements.
Have you ever been convicted of a felony?*

YesNo
If yes, please give date and nature of offense, city, county, state and any fines and time served
Please list EVERYTHING asked for per isurance requirements
Have you ever been convicted of a misdemeanor?*

YesNo
If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines
Please list EVERYTHING asked for
Have you ever had any work related injuries?*

YesNo
If so, please list date, details of injury,time off work and any current restrictions you may have from the injury.
HIGH SCHOOL
Name & City/State of High School
Did you graduate?

YesNo
By signing I agree I have read the above statements
Should be Empty:

General Information

License Information

EMPLOYMENT HISTORY

Moving Violations/Accidents