Driver Application
800 Williams Road Montrose, PA 18801 - (570)278-1080 - office@rhlcompanies.com
GENERAL INFORMATION
Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you 21 years or older?
How long are you willing to stay out of town for work:
1-2 nights a week
All week, home on weekends
A few weeks at a time
RESIDENCE PAST 10 YEARS
In the text below please add the Address, City, Street, Zip Code, and for how long you were located at that residence.
Provide Information Here:
Provide Information Here:
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EXPERIENCE AND QUALIFICATIONS - DRIVER
Make a photo copy of the driver's license and medical certificate! Applicants list the states and license number of all the licenses held for the past 3 years. In the text below please add the State, License #, Expiration Date, Class A or B, and Endorsements.
Provide Information Here:
Provide Information Here:
Do you have any restrictions on your CDL?
DRIVING EXPERIENCE
In the text below please add Types of Equipment Van, Flat, Tank, etc, the Dates To-From, and Approximate # of Miles Total for each type of equipment.
Equipment Class: Straight Truck
Equipment Class: Tractor Semi Trailer
Equipment Class: Tractor with Doubles
Equipment Class: Tractor with Triples
Equipment Class: Tractor with Tanks
Equipment Class: Other
ACCIDENTS/CRASHES FOR THE PAST 3 YEARS OR MORE
In the box below please add the Date, Nature of Accident (Backing, Head-on, Rollover, Turning), Fatalities, Injuries of these accidents.
Provide Information Here:
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MOVING TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS
In the text below please add the Date of Conviction, Offense, Location, and Type of Motor Vehicle Operated for each conviction.
Provide Information Here:
Provide Information Here:
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Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Please Select
Yes
No
If yes, please attach statement giving details.
Has any license, permit, or privilege been revoked?
Please Select
Yes
No
If yes, please attach statement giving details.
This company requires all Drivers who drive Commercial Motor Vehicles (CMV) which require a Commercial Driver's License (CDL), to be controlled substances tested with a negative result prior to driving. Do you consent to such testing?
Please Select
Yes
No
EMPLOYMENT RECORD
All for the past 3 years and Commercial Driving Experience for the past 10 years.
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Personal References:
Reference:
Name:
Street Address Line 2
Relationship:
Telephone Number:
Postal / Zip Code
Reference:
Name:
Street Address Line 2
Relationship:
Telephone Number:
Postal / Zip Code
This certifies that this application was completed by me, and that all entries on it and information in it are true to the best of my knowledge.
Submit
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