DRIVER’S APPLICATION FOR EMPLOYMENT

- DRIVER’S APPLICATION FOR EMPLOYMENT
- Name
  
  First NameLast Name
- Date of Application
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
- TO BE READ AND SIGNED BY APPLICANT
- I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)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 inter-view(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
  
  I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23(d) and (e). I understand that I have the right to:
  - • Review information provided by previous employers;
  - • Have errors in the information corrected by previous employers and for those previous employers to re-send 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 can not agree on the accuracy of the information.
- Signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- APPLICANT TO COMPLETE
  
  Personal Information
- Position(s) Applied for
- Last
- First
- Middle
- Social Security No.
  xxx-xx-xxxx
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Type a question
- How long have you lived here
  YR/MO
- Phone Number
  Format: (000) 000-0000.
- Have you lived in any other address in the last 3 years?
- List your addresses of residency for the past 3 years.
- Previous Address 1
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- How long have you lived here
  YR/MO
- Previous Address 2
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- How long have you lived here
  YR/MO
- Previous Address 3
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- How long have you lived here
  YR/MO
- Do you have the legal right to work in the United States?
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Can you provide proof of age?
- Have you worked for this company before?
- Where?
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Rate of Pay
- Position
- Reason for leaving
- Are you now employed?
- If not, how long since leaving last employment?
- Who referred you?
- Have you ever been bonded?
- Name of bonding company
- Have you ever been convicted of a felony?
- If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered. If your state does not allow for this question please select N/A.
- Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?
- If yes, explain if you wish.
- EMPLOYMENT HISTORY
- All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.
  
  Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary)
- Current Employer
  
  Most Recent If not currently employed.
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- Have you worked for any other company in the last 3 years that has not been listed?
- Employment History Continued
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- Have you worked for any other company in the last 3 years that has not been listed?
- Employment History Continued
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- Have you worked for any other company in the last 3 years that has not been listed?
- Employment History Continued
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- Have you worked for any other company in the last 3 years that has not been listed?
- Employment History Continued
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- Have you worked for any other company in the last 3 years that has not been listed?
- Employment History Continued
- Name Of Employer
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Contact Person
- Phone Number
  Format: (000) 000-0000.
- From
  Month/Year
- To
  Month/Year
- POSITION HELD
- SALARY/WAGE
- REASON FOR LEAVING
- WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?
- 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?
- *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
  
  The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
- Accident Records
- Have you had a accident in the last 3 years?
- Accident 1
- Date of accident
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Nature of Accident
  (HEAD-ON, REAR-END, UPSET, ETC.)
- Fatalities
- Injuries
- Hazardous Material Spill
- Any other accidents to report in the last 3 years?
- Accident 2
- Date of accident
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Nature of Accident
  (HEAD-ON, REAR-END, UPSET, ETC.)
- Fatalities
- Injuries
- Hazardous Material Spill
- Any other accidents to report in the last 3 years?
- Accident 3
- Date of accident
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Nature of Accident
  (HEAD-ON, REAR-END, UPSET, ETC.)
- Fatalities
- Injuries
- Hazardous Material Spill
- If you have more to report in the last 3 years, Please contact Recruiting.
- TRAFFIC CONVICTION
  
  TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)
- Have you had any Traffic Convictions in the last 3 years?
- Traffic Conviction 1
- Location
  Town and State
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate of citation
- Charge
- Penalty
- Any others Traffic Convictions to report?
- Traffic Conviction 2
- Location
  Town and State
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate of citation
- Charge
- Penalty
- Any others Traffic Convictions to report?
- Traffic Conviction 3
- Location
  Town and State
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate of citation
- Charge
- Penalty
- If you have more to report in the last 3 years, Please contact Recruiting.
- EXPERIENCE AND QUALIFICATIONS – DRIVER
- Drivers Licenses History
  
  List all driver licenses or permits held in the past 3 years
- State
- License No.
- Type
- Expiration Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Any other License to Report?
- Drivers Licenses 2
- State
- License No.
- Type
- Expiration Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Any other License to Report?
- Drivers Licenses 3
- State
- License No.
- Type
- Expiration Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Have you ever Been Denied a License, Permit or Privilege to operate a motor Vehicle
- Has any license, permit or privilege ever been suspended or revoked?
- IF THE ANSWER TO EITHER QUESTION WAS YES, GIVE DETAILS
- Driving Experience
  
  Have you driven any of the following
- STRAIGHT TRUCK
- Type of Equipment
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- TRACTOR AND SEMI-TRAILER
- Type of Equipment
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- TRACTOR - TWO TRAILERS
- Type of Equipment
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- TRACTOR - THREE TRAILERS
- Type of Equipment
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- MOTORCOACH - SCHOOL BUS More than 8 Passengers
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- MOTORCOACH - SCHOOL BUS More than 15 Passengers
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- Any other Commercial Vehicle?
- What was it?
- From
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- To
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Approx. No. Of Miles
  Miles
- LIST STATES OPERATED IN FOR LAST FIVE YEARS:
- SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:
- WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?
- EXPERIENCE AND QUALIFICATIONS – OTHER
- SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY
- LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION
- LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)
- EDUCATION
- Highest Grade Completed
- Last School Attended (Name)
  Name of School
- Last School Attended (Location)
  City, State
- TO BE READ AND SIGNED BY APPLICANT
- This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
- Signature:
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Should be Empty:

DRIVER’S APPLICATION FOR EMPLOYMENT

TO BE READ AND SIGNED BY APPLICANT

APPLICANT TO COMPLETE

EMPLOYMENT HISTORY

Current Employer

Employment History Continued

Employment History Continued

Employment History Continued

Employment History Continued

Employment History Continued

Accident Records

Accident 1

Accident 2

Accident 3

TRAFFIC CONVICTION

Traffic Conviction 1

Traffic Conviction 2

Traffic Conviction 3

EXPERIENCE AND QUALIFICATIONS – DRIVER

Drivers Licenses History

Drivers Licenses 2

Drivers Licenses 3

Driving Experience

EXPERIENCE AND QUALIFICATIONS – OTHER

EDUCATION

TO BE READ AND SIGNED BY APPLICANT