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

MonthDayYear
Date
DRIVER EXPERIENCE
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?

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

YesNo
If you answered yes to either of the above 2 questions, attach a statement of explanation.
TICKETS, ACCIDENTS, ETC
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
HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR
I have worked for EB FREIGHT LLC before
(If yes, please indicate hire and termination dates)

YesNo
Hire date

MonthDayYear
Date
Termination Date

MonthDayYear
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)

YesNo
How did you hear about this employer?
EMPLOYMENT RECORD
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?

YesNo
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?

YesNo
Employer:
Employed From:
To:
Address:
Phone:
Supervisor:
Position:
Reason for leaving
Were you subject to FMCRSs while employed?

YesNo
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?

YesNo
Employer:
Employed From:
To:
Address:
Phone:
Supervisor:
Position:
Reason for leaving
Were you subject to FMCRSs while employed?

YesNo
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?

YesNo
Employer:
Employed From:
Address:
Phone:
Supervisor:
Position:
Reason for leaving
Were you subject to FMCRSs while employed?

YesNo
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?

YesNo
Employer:
Employed From:
To:
Address:
Phone:
Supervisor:
Position:
Reason for leaving
Were you subject to FMCRSs while employed?

YesNo
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?

YesNo
Employer:
Employed From:
Address:
Phone:
Supervisor:
Position:
Reason for leaving
Were you subject to FMCRSs while employed?

YesNo
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?

YesNo
ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE
Have you ever refused to be tested for drugs and alcohol?

YesNo
Have you ever tested positive for drugs or alcohol?

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

YesNo
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

Cancelof
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

Clear
Date

MonthDayYear
Date
Print name
Social Security Number
EB FREIGHT LLC
Please upload a picture of your DOT medical certificate

Cancelof
Please upload a picture of your driver's license

Cancelof
Should be Empty:

DRIVER EXPERIENCE

TICKETS, ACCIDENTS, ETC

HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR

EMPLOYMENT RECORD