McCartney Drivers Employment

Commercial Driver Application
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Name

First NameMiddle NameLast Name
Email
example@example.com
Home Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
* If at the above residence less than three years, list below all residences for the past three years.
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Applying For
Employment Status

TemporaryPart TimeFull Time
Who Referred You?
If no one, write none
Rate of Pay Expected?
Have You Ever Worked for this Company?
Dates:
From Month/Year to Month/Year
Where?
Rate of Pay
Position
Reason For Leaving
Names of any relatives employed by this company
Are You Currently Employed
If not, how long since leaving last employment?

Education
Highest Grade Completed
Name of Last School Attended
Address of Last School Attended
Military Experience
Have you ever served in the U.S. Armed Forces?

yesno
If yes, which branch of service
Describe any military training received relevant to the position for which you are applying.
Are you currently serving in Military Reserves?

YesNo
Are you currently serving in National Guard?

YesNo
General
Have you ever been bonded?
If yes, Name of Bonding Company
(Answer only if a job requirement)
Have you ever been convicted of a felony?
If yes, please explain below.
Conviction of crime is not an automatic bar to employment - all circumstances will be considered.

Driver Experience And Qualifications
The Motor Federal Carrier Safety Regulations (49CFR391.21 (b) (2) requires that driver applicants state their date of birth and SS #.
Date of Birth
month/day/year
Social Security Number
Physical History
The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.
Date of last Department of Transportation prescribed examination

MonthDayYear
Date
Can you provide a copy
Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the No loss of foot, leg, hand or arm?

YesNo
Alcohol and Controlled Substance Statement
The Federal Motor Carrier Safety Regulations 49CFR40.25(j) requires all persons with applying for a driving position requiring a commercial drivers license to answer the following questions:

1) Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

no yes 2) Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?yes

3) If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?
Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

YesNo
Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?

YesNo
If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

YesNo
Applicants Signature

Clear
Date

MonthDayYear
Date
Witnessed By
Date

MonthDayYear
Date

Driver's License Information
Driver Licenses held in past 3 years must be shown

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

Driver Licenses Held in the past 3 years must be shown.

	State	License Number	Type	Expiration Date
Current
Previous
Previous
Previous

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

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

YesNo
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

YesNo
Yes If you answered "Yes" to A, B, or C, attach a statement giving details.

Type a question

	Type of Equipment (Van, Tank, Flat, etc.)	Dates From To	Approximate Total Miles
Straight Truck
Tractor and Semi Trailer
Twin
Other

List states operated in during the last five years:
List special courses or training that will help you as a driver:
List safe driving awards held and who awards were presented by:
Driver Experience And Qualification

(continued)

Accident Review for the past 3 years

	Date	Nature of Accident (Head-On, Rear-End, Upset, etc.)	# Fatalities	# Injuries	# Vehicles Towed	Citation Issued?
1.
2.
3.
4.
5.

Motor Vehicle Driving Record (MVR)

Traffic Convictions and Forfeitures for the past 3 years other than parking violations

	Date	Location	Charge	Penalty
1
2
3
4

Employment Record
The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained. Start with the last or current position, including any military experience, and work back (Attach separate sheet if necessary You are required to list the complete mailing address: street number, city, state and zip code.
Current Employer
Supervisor's Name
Address
Phone:
Position Held
Date From
Date To
Salary
Reason for Leaving
Previous Employer
Supervisor's Name
Address
Phone:
Position Held
Date From
Date To
Salary
Reason for Leaving
Previous Employer
Supervisor's Name
Address
Phone
Position Held
Date From
Date To
Salary
Reason for Leaving
Previous Employer
Supervisor's Name
Address
Phone
Position Held
Date From
Date To
Salary
Reason for Leaving
Previous Employer
Supervisor's Name
Address
Phone
Position Held
Date From
Date To
Salary
Reason for Leaving
Previous Employer
Supervisor's Name
Address
Phone
Position Held
Date From
Date To
Salary
Reason for Leaving

APPLICANT MUST READ AND SIGN
I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.

This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.
Date

MonthDayYear
Date
Applicant's Signature

Clear
Should be Empty:

Commercial Driver Application

Education

Military Experience

General

Driver Experience And Qualifications

Physical History

Alcohol and Controlled Substance Statement

Driver's License Information

Driver Experience And Qualification

Motor Vehicle Driving Record (MVR)

Employment Record

APPLICANT MUST READ AND SIGN