Garman Trucking

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Previous 3 years residency.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you lived at any other residencies in the past 3 years?*

YesNo

Secondary Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Tertiary Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Equipment Experience

Straight TruckTractor & Semi-TrailerTractor - 2 trailersOther

Straight Truck (Years Of Experience)

Straight Truck (Approx. Miles)

Tractor & Semi-Trailer (Years Of Experience)

Tractor & Semi-Trailer (Approx. Miles)

Tractor - 2 Trailers (Years of Experience)

Tractor - 2 Trailers (Approx. Miles)

Other (Years of Experience)

Other (Approx Miles)

Any accidents in the past 3 years?*

YesNo

Accident Date:

Date

Accident Type:

rear-end, upset, head-on, etc

Fatalities or Injuries?

List number of injured

Chemical Spill?

YesNo

Any additional accidents in the past 3 years?

YesNo

Please list details of additional accidents:

Have you had any traffic convictions or forfeitures over the past 3 years?*

YesNo

Please list dates, violations, state of occurrence, and penalties.

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

YesNo

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

YesNo

Have you ever been convicted of a felony?*

YesNo

Previous Employer*

Previous Employer Phone*

Please enter a valid phone number.

Employment Dates:

Previous Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Held*

Reason For Leaving*

Previous Employer (2)*

Previous Employer Phone(2)*

Please enter a valid phone number.

Employment Dates (2):

Previous Employer Address(2)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Held (2)*

Reason For Leaving (2)*

Previous Employer (3)*

Previous Employer Phone(3)*

Please enter a valid phone number.

Employment Dates (3):

Previous Employer Address(3)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Held (3)*

Reason For Leaving (3)*

I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employm ent decision . (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers , schools , health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my
application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also , that I am required to abide by all rules and regulations of the Company.
“I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to:

• Review Information Provided By Current/Previous Employer
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer: and
• Have a rebuttal statement attached to the alleged erroneous information , if the previous employer(s) and I can not agree on the accuracy of the information.“

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. *Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal MotorCarrier Safety Regulations.*

Garman Trucking, LLC is a drng and alcohol free work place. Terms of Employment are
mandatory pre employment testing as well as random testing for all employees.
In the event that I am in an accident or am injured while working for Garman Trncking,
LLC, I will be asked to take a drng test. I understand that if I refuse to take the drug test
or if I fail the drug test that it will be automatic termination and that I will be responsible
for any bills and expenses as a result of this occurrence and will be ineligible for workers
compensation.

I understand that there is a no tolerance drug testing policy and I agree to these terms as part of my employment at Garman Trucking, LLC.

Application For Employment

Previously Employment: