DRF Truck Driver Application

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 - No matter WHO you drive for!

Full Name*

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Were you at this address 3 years or more

YesNo

List previous address(es), other than that above, for the past 7 years.

Social Security Number*

Date of Birth*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

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 18 years of age or older?*

YesNo

Position Applying For

Can you accept a job immediately?*

YesNo

If so, how soon?

Do you have friends, or members of your family working here?

YesNo

Who?

Have you ever been discharged from any job?*

YesNo

If so give reason?

What prompted you to apply with us?

Are you capable of performing the essential functions of a physically demanding job, with or without reasonable accommodations?*

YesNo

Upload Your Resume

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EDUCATION

Name & City/State of High School

Did you graduate/equivalent?

YesNo

Name & City/State of College

Did you graduate?

YesNo

What job qualifications, skill, or professional certificates do you posses?

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*

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.

Have you been to truck driving school?

YesNo

School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry

School phone number

Area CodePhone Number

Did you graduate?

YesNo

Note: A conviction will not necessarily bar an applicant from employment. Conviction records ordered sealed or expunged by a court need not be disclosed.

Have you had any moving violations in the last 7 years?*

YesNo

If yes, please list City, County and State, month, year 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

If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)

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 insurance requirements.

Have you tested positive for a required DOT Pre-Employment drug/alcohol test over the past three years?*

YesNo

Have you ever been convicted of a misdemeanor?*

YesNo

If yes, please give the name of the company worked for that administered the tests.*

Have you refused to take a required DOT Pre-Employment drug/alcohol test test over the past three years?*

YesNo

If yes, please give the name of the company worked for that administered the tests.*

Please list current, or most recent employment first.

May we contact your present employer*

YesNo

May we contact your previous employer(s)*

YesNo

Start date*

MonthDayYear

Ending date*

MonthDayYear

Employer Name*

Employer phone*

Area CodePhone Number

City, State

Position Held*

Name of Supervisor *

Wage Rate

Reason for leaving

Was this a driving position

YesNo

Type of truck driven

Number of states driven

NEXT EMPLOYER

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

Employer phone

Area CodePhone Number

City, State

Position Held

Name of Supervisor

Wage Rate

Reason for leaving

Was this a driving position

YesNo

Type of truck driven

Number of states driven

NEXT EMPLOYER

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

Employer phone

Area CodePhone Number

City, State

Position Held

Name of Supervisor

Wage Rate

Reason for leaving

Was this a driving position

YesNo

Type of truck driven

Number of states driven

Reference 1

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Years Known *

Occupation *

Reference 2

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Years Known *

Occupation *

Reference 3

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Years Known *

Occupation *

Please read carefully the following statement. Your signature at the bottom of this application shall be considered conclusive of evidence that you have take care in filling out the application and that it is accurate. I authorize investigation of all statements contained in this application. Further, I understand that any misleading or incorrrect statements may render any offer of employment based on this application void, and if employed by Deal-Rite Feeds, Inc. may be cause for termination. I understand that any offer of employment with Deal-Rite Feeds Inc. is conditioned upon the results of a medical examination confirming my ability to perform the essential functions of the position offered with or without reasonable accommodation, as well as upon the return of a negative result from a drug screen test.

Date*

Date

By signing I have read and agree to the above statements. *

Release and Authorization for Motor Vehicle Report

I authorize Deal-Rite Feeds, Inc. to obtain a personal Driving History Report upon verification of my signature at the end of this form. Furthermore, I release all agencies, bureaus, information service organizations, and individuals or companies named above from all liabilities of damages that might result from information provided in good faith. I understand that the information requested below regarding sex, race, and date-of-birth are for the sole purpose of gather the above information accurately and will not be used to discriminate against me in violation of the law. A facsimile (FAX) or photograpy of this authorization shall be as valid as the original.

*In compliance with the FCRA: I understand upon my signature a consumer report is being requested. I further understand Qualifying Profiles, Inc. is only a reporting agency and in now way can alter, change, or interpret a report. Therefore, I release QPI from any responsibilities or disputes resulting from the report. For inquiries, I have a right to contact the appropriate Credit Reporting Agengy within a reasonable amount of time. A release is required to be signed and kept on file.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I have read and agree to the above statements. *

Release Authorization

In consideration of my application, I authorize Deal-Rite Feeds Inc. by and through QPI to verify all data given by me on application, related paper or oral interviews. I understand a thorough investigation may be conducted which may include but not be limited to criminal history, motor vehicle driving record, education verification, employment history, credit report and personal history. I hereby authorize employers, agencies personal references and other persons with whom I am acquainted to answer all questions and release all information concerning my employment record, character, reputation, ability, education, military service, credit history, and other applicable reports. Furthermore I release all agencies, bureaus, employers, information service organizations, and individuals or companies named above from all liabilities or damages that might result from information provided in good faith. I state that the information provided by me on my application is accurate and I agree that if any information therein is found to be false at any time, my application may be discarded or my employment terminated. I understand that the information requested below regarding sex, race, and date-of-birth are for the sole purpose of gathering the above information accurately and will not be used to discriminate against me in violation of the law*. A facsimile (FAX) or photograpy of this authorization shall be as valid as the original.

*QPI fully complies with the Fair Credit Reporting Act and the ADA.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I have read and agree to the above statements. *

Release Authorization for FMCSA Drug Clearinghouse

I provide consent to Deal-Rite Feeds Inc. to conduct a limited or full query of
the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I also give continued consent to a limited or full query every year for the duration of employment by Deal-Rite Feeds Inc.

I understand that if the limited query conducted by Deal-Rite Feeds Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Deal-Rite Feeds Inc. without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for Deal-Rite Feeds Inc. to conduct a
limited query of the Clearinghouse, Deal-Rite Feeds Inc. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I have read and agree to the above statements. *

General Information

Please Answer the Following Questions

License Information

Legal Record

EMPLOYMENT HISTORY

References

Additional Information