Executive Chauffeur Job Application Form

  • PRE-EMPLOYMENT APPLICATION

    Position: Executive Chauffeur

  • Kevin Smith Transportation Group

    6 Egypt Road, West Norriton, PA 19403

     

    The Kevin Smith Transportation Group is an equal opportunity employer and will consider all qualified applicants for all positions equally without regard to their veteran status, uniformed service member status, race, color, religion, sex, age, pregnancy, national origin or ancestry, physical or mental disability, genetic information or any other consideration protected by federal, state, or local law.

    This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have bee answered.

  • PERSONAL INFORMATION

  • Date:*
     / /
  • Format: (000) 000-0000.
  • Date of Birth:*
     / /

  • LICENSE AND DRIVING HISTORY:

  • List all driver's licenses and permits you have held in any state within the last 3 years.

  • Driver's License Expires:*
     / /
  • Driver's License Currently Valid?*
  • Driver's License Type:*
  • Driver's License Endorsement (CDL drivers only):
  • Have you had any other licenses or permits within the last 3 years?*
  • Driver's License Expires:*
     / /
  • Driver's License Currently Valid?*
  • Driver's License Type:*
  • Driver's License Endorsement (CDL drivers only):
  • Have you had any other licenses or permits within the last 3 years?*
  • Driver's License Expires:*
     / /
  • Driver's License Currently Valid?*
  • Driver's License Type:*
  • Driver's License Endorsement:
  • Has at any point your license, permit or privilege to operate a motor vehicle ever been denied, revoked, or suspended?*
  • Have you ever been disqualified under §383 or §391 of the Federal Motor Carrier Safety Regulations?*
  • Have you ever been convicted of any crime (excluding minor traffic violations) including driving while under the influence of alcohol or drugs?*
  • Have you been convicted of any traffic violations (other than parking) within the past 3 years?*
  • Have you been involved in any motor vehicle accidents within the past 3 years?*

  • EMPLOYMENT DESIRED

  • Are you seeking:*
  • Available start date:*
     / /
  • Have you ever applied to or worked for our company before?*
  • How did you learn about this position?*

  • In a typical week are there any days or hours you would be unable or unwilling to work?*
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  • EDUCATION

  • Are you interested in providing educational information?*
  • Highest Level Completed:*

  • Graduated:*
  • Recognition Received:*

  • CAPABILITY/RELIABILITY

  • Would you be willing and able to perform all of the tasks required by the job you are applying for?*
  • Have you filed any type of fraudulent claim against any of your present or past employers?*
  • Will you abide by the safety of this company?*
  • Have you ever been disciplined for violating company safety rules or regulations?*

  • WORK HISTORY

  • List names of non-DOT regulated employers for the past 3 years, and names of all DOT regulated employers for the past 10 years in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

    PLEASE FILL ADDRESSES OUT COMPLETELY.

  • Format: (000) 000-0000.
  • Were you regulated by the Federal Motor Carrier Safety Administration (FMCSA) during employment?*
  • Were you designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements by 49 CFR part 40?*
  • Would you like to add additional employment history information?*
  • Format: (000) 000-0000.
  • Were you regulated by the Federal Motor Carrier Safety Administration (FMCSA) during employment?*
  • Were you designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements by 49 CFR part 40?*
  • Would you like to add additional employment history information?*
  • Format: (000) 000-0000.
  • Were you regulated by the Federal Motor Carrier Safety Administration (FMCSA) during employment?*
  • Were you designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements by 49 CFR part 40?*
  • Would you like to add additional employment history information?*
  • Format: (000) 000-0000.
  • Were you regulated by the Federal Motor Carrier Safety Administration (FMCSA) during employment?*
  • Were you designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements by 49 CFR part 40?*
  • Would you like to add additional employment history information?*
  • Format: (000) 000-0000.
  • Were you regulated by Federal Motor Carrier Safety Administration during employment?*
  • Were you designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?*

  • In accordance with FMCSA regulation 391.21; paragraph (b)(10) the applicant's previous employers will be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraphs (d) and (e) of 391.23. The prospective employer must also notify the driver in writing of their due process rights as specified in 391.23(i) regarding information received as a result of these investigations.

    ***NOTE: An individual Investigation into Safety Performance History form will be sent to each employer listed above.

  • REFERENCES

    Give three character references that are not relatives or former employers. This section is optional, but encouraged.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • RESIDENTIAL HISTORY

  • List your residence history for the past 3 years, starting with your current address. Please include street address and state. Do not leave any blank gaps in time.

  • Would you like to add additional residential history information?*
  • Would you like to add additional residential history information?*

  • AFFIDAVIT

         I recognize that if I am employed, an initial driving history check and criminal background check are required by Kevin Smith Transportation Group. I also acknowledge that additional driving history checks will be required annually. I hereby consent Kevin Smith Transportation Group to conduct an initial driving history check and criminal backgroud check, as well as annual driving checks for the duration of my employment.

         I certify that my answers to the foregoing questions are true without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

         I hereby authorize Kevin Smith Transportation Group to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. I also understand that my employment is "at-will" and may be terminated by myself or by the company at any time for any reason or no reason at all, with or without prior notice.

         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.

     

  • Date*
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  • Should be Empty: