Copana Job Application

www.copanaenterprises.com
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.
You are applying for a driving job with Copana Enterprises.
Position Applying For
How did you hear about this position?
Craig's list, referral, other
General Information
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Were you at this address 3 years or more

YesNo
Please list 1 prior address here and please be complete
Social Security Number*
Will be kept secure, used for background check and 1099, or W2
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Have you ever been known by any other name?

YesNo
Please list name
Explain ie; maiden name, name change
If hired, can you furnish proof you are eligible to work in the U.S.?*

YesNo
Are you at least 23 years of age or older?*

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

YesNo
License Class*
Class A Required
License Number*
State of Issue*
License date of Issuance*

MonthDayYear
Date
License expiration date*

MonthDayYear
Provide a copy of your driver's license here

Browse Files
Provide at first meeting if unable to upload a file Cancelof
CDL Endorsements*

NoneTankerDoubles/TriplesHazmatX EndorsementTWIC
CDL Issuance Date*

MonthDayYear
Approximate date is okay
CDL Experience*
Hazmat expiration date

MonthDayYear
TWIC expiration date

MonthDayYear
Please list any licenses held in other states for the previous 5 years, include license numbers if you can.
Were you ever in the military?*

YesNo
Branch of service
Please list Dates of enlisment
Enlist date - Discharge date
Are you willing to take a Drug Test BEFORE hiring as required by DOT?

YesNo
Expiration date of DOT physical card

MonthDayYear
Upload a copy of your DOT card

Browse Files
Or Provide a copy at first meeting Cancelof
Have you been to truck driving school?

YesNo
If yes, which driving school
Upload Copy of Driving School Completion Certificate

Browse Files

Cancelof
Highest Education Information

School Name

Dates of attendance

CityState / Province

Type of DegreeCountry
Did you graduate?

YesNo
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
Type of truck
Type of trailer
Trailer length
Number of states 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
Type of truck
Type of trailer
Trailer length
Number of states 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
Type of truck driven
Type of trailer
Trailer length
Number of states driven
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
Type of truck driven
Type of trailer
Trailer length
Number of states driven
If you need additional space for past employment, please enter it here and include ALL information previously asked for.
Additional Information
Have you had any moving violations in the last 3 years?*

YesNo
Has your license 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
If yes, please list nature of offense and any fines involved
Please list miles over limit for speeding
Have you had any accidents in the last 3 years?*

YesNo
If yes, please give date, explanation, city, county and state and if you received ticket/fine (amount)
Note: This information is needed for insurance
Have you ever had a DUI, DWI, or OVI?Operating a Vehicle under the Influence*

YesNo
If yes, please list date of offense, jail time, fine and or suspension time.
We must have complete information to satisfy issuance 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 insurance requirements. Please be forthcoming this will come up on our background check it will not be held against you.
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. Please be forthcoming this will come up on our background check it will not be held against you.
Additional Information
References: Please list name, address, phone and years known.
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Number of years known
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Number of years known
Emergency contact information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship to you*
Phone Number*

Area CodePhone Number
Certify all information is accurate
By signing I agree I have read the above statements
Should be Empty:

www.copanaenterprises.com

General Information

License Information

EMPLOYMENT HISTORY

Additional Information

Additional Information

References: Please list name, address, phone and years known.

Emergency contact information

Certify all information is accurate