DRIVER'S APPLICATIONFOR EMPLOYMENT

DRIVER'S APPLICATION FOR EMPLOYMENT
Applicant Name
Date of Application

MonthDayYear
Date
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment 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 I have the right to:
- Review information provided by previous employers;
- 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 cannot agree on the accuracy of the information.
Signature
Date

MonthDayYear
Date

APPLICANT TO COMPLETE

(answer all questions - please print)
Position(s) Applied for
Name

First NameMiddle NameLast Name
Social Security No.
List your addresses of residency for the past 3 years.

Current Address

Rows	Street	City	State	Zip Code	Phone	How Long?(yr./mo.)
1
2

Previous Addresses

Rows	Street	City	State & Zip Code	How Long?(yr./mo.)
1
2
3

Do you have the legal right to work in the United States?
Date of Birth

MonthDayYear
Date
Can you provide proof of age?

(Required for Commerical Drivers)
Cancelof
Have you worked for this company before?
Where?
Dates: From Date To Date
Rate of Pay
Position
Reason for leaving
Are you now employed?
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected
Have you ever been bonded?
(Answer only if a job requirement)
Name of bonding company
Is there any reason you might be unable to perform the functions of the job for which you have applied
As described in the attached job description?

Cancelof
Explain if you wish.

Rows	DATES	NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.)	FATALITIES	INJURIES	HAZARDOUSMATERIAL SPILL
LAST ACCIDENT
NEXT PREVIOUS
NEXT PREVIOUS

Rows	LOCATION	DATE	CHARGE	PENALTY
1
2
3

Rows	STATE	LICENSE NO.	CLASS	ENDORSEMENT(S)	EXPIRATION DATE
1
2
3
4

Rows	Yes/No	TYPE OF EQUIPMENT	DATES FROM(M/Y)	DATES TO(M/Y)	APPROX. NO. OF MILES (TOTAL)
STRAIGHT TRUCK
TRACTOR AND SEMI-TRAILER
TRACTOR - TWO TRAILERS
TRACTOR - THREE TRAILERS
MOTORCOACH - SCHOOL BUS
MOTORCOACH - SCHOOL BUS
OTHER

DRIVER'S APPLICATION FOR EMPLOYMENT

APPLICANT TO COMPLETE

EMPLOYMENT HISTORY

EMPLOYER

EMPLOYMENT HISTORY

EMPLOYER

EMPLOYER

EMPLOYER

EMPLOYER

EMPLOYER

ACCIDENT RECORD

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION