EB FREIGHT LLC, DRIVER'S EMPLOYMENT APPLICATION

(First Name)

(Middle Name)

(Last Name)

Current Address

(Street)

(City)

(State,Zip)

How long?

Must list all address for previous 3 years.

(Street)

(City)

(State,Zip)

How long?

(Street)

(City)

(State,Zip)

How long?

Email address:

example@example.com

Phone #:

DOB:

SSN:

Emergency Contact Name:

Relation:

Contact Address:

Phone #

DRIVER'S LICENSE INFORMATION

State

License #

Type

Expiration Date

Date

Type of Equipment

From (Date)

To (Date)

Approx # of miles

Type of Equipment

From (Date)

To (Date)

Approx # of miles

Type of Equipment

From (Date)

To (Date)

Approx # of miles

Have you ever been denied a license, permit or privilege to a motor vehicle?

Has any license, permit or privilege ever been suspended or revoked?

If you answered yes to either of the above 2 questions, attach a statement of explanation.

Accident Record for Past 3 Years

Date

Description

# of Injuries/Fatalities

Date

Description

# of Injuries/Fatalities

Date

Description

# of injuries/Fatalities

Traffic Convictions & Forfeitures for Past 3 Years

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

I have worked for EB FREIGHT LLC before

(If yes, please indicate hire and termination dates)

Hire date

Date

Termination Date

Date

Note: This information should also be reflected in employment record section.

I have applied for work with EB FREIGHT LLC before (If yes please indicate dates)

How did you hear about this employer?

Note: DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown

Employer:

Employed From:

To:

Address:

Phone:

Supervisor:

Position:

Reason for Leaving:

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

Employer:

Employed From:

To:

Address:

Phone:

Supervisor:

Position:

Reason for leaving

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

Employer:

Employed From:

To:

Address:

Phone:

Supervisor:

Position:

Reason for leaving

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

Employer:

Employed From:

Address:

Phone:

Supervisor:

Position:

Reason for leaving

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

Employer:

Employed From:

To:

Address:

Phone:

Supervisor:

Position:

Reason for leaving

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

Employer:

Employed From:

Address:

Phone:

Supervisor:

Position:

Reason for leaving

Were you subject to FMCRSs while employed?

Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

Have you ever refused to be tested for drugs and alcohol?

Have you ever tested positive for drugs or alcohol?

Have you ever tested positive on any pre-employment drug or alcohol test for a job which you applied for but did not obtain?

If you answered yes to any of the above questions, attach a statement of explanation and provide proof of return to duty process

Please upload proof of return to duty

I understand that, as required by the Federal Motor Carrier Safety Regulations and company policy, all drivers must submit to alcohol and controlled substance testing as a condition of employment. I also understand that any offer of employment will be contingent upon the results of an alcohol and controlled substance test.

Therefore, I agree to submit to the following alcohol and controlled substance tests in accordance and as defined by the Federal Motor Carrier Safety Regulation and this company's policies:

Pre-Employment, to determine employment eligibility
Random
Reasonable Suspicion
Post-Accident

I certify that I have read, understand and agree to abide by the condition of this consent and release form

Applicant's Signature

Date

Print name

Social Security Number

EB FREIGHT LLC

Please upload a picture of your DOT medical certificate

Please upload a picture of your driver's license

DRIVER EXPERIENCE

TICKETS, ACCIDENTS, ETC

HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR

EMPLOYMENT RECORD