Commercial Driver Application for At-Will Employment

Commercial Driver Application for At-Will Employment
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT, but is merely intended to evaluate suitability for employment. It is our policy to provide equal opportunity for employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state or federal law. It is also our policy to conduct pre-employment drug screenings before a job offer is made. If a job offer is made, employment will be contingent upon successful completion of a pre-employment drug screen.

Do not leave any blanks on this application
POSITION(S) APPLIED FOR *
Last Name *
First Name *
Middle Name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone (Home)
Phone (Cell) *
Social Security *
Driver’s License *
Expiration Date *

Month Day Year
Date
Medical Examiner’s Certificate Expiration
Date *
E-mail *
Date of Birth

Month Day Year
Date
Have You Ever Worked For TJS Before? *

Y N
Position
Dates (From/To)
Rate of Pay
Reason for leaving
Expected pay
How did you hear about us?
Are you eligible to work in the United States? *

Y N
Do you currently hold a Weigher & Sampler License? *

Y N
If Yes, expiration date
COMMERCIAL DRIVING EXPERIENCE
Do you have a current Class "A" commercial driver's license? *

Y N
How many years?
Total OTR Experience *
Tractor W/ Doubles *
Tractor W/Semi-Trailer *
Other
Other
LICENSE REQUIREMENTS: (List all licenses held for the past 5 years)
DRIVER'S LICENSE CLASS *
License Number *
State *
Expiration Date *

Month Day Year
Date
DRIVER'S LICENSE CLASS
License Number
State
Date

Month Day Year
Date
DRIVER'S LICENSE CLASS
LICENSE NUMBER
STATE
Date

Month Day Year
Date
DRIVER'S LICENSE CLASS
LICENSE NUMBER
STATE
Date

Month Day Year
Date
(Attach additional page if needed)

TJS Leasing & Holding Company, Inc., 1850 Murray Road, McKinleyville, CA 95519,T: 707.269.2420,F: 707.269.2424, www.TJSamerica.com
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *

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

Y N
Have you ever been disqualified subject to Section 391 of the Federal Motor Carrier Safety *

Y N
*If the answer to either A, B, or C is yes, please attach sheet giving details, including dates*
WORK HISTORY: Please explain all gaps in employment of 30 days or more. Applications must list ALL jobs held in the last 10 years. Please attach additional pages if needed.
Last Employer (Company Name) *
Address (City, State, Zip) *
Phone *
Position Held *
From *

Month Day Year
Date
To *

Month Day Year
Date
Reason for Leaving *
May we contact? *

Y N
Were you subject to the FMCR's *

Y N
Was the job designated as a Safety Sensitive function in any DOT regulated mode subject to drug and alcohol testing as required by 49CFR part 40? *

Y N
Company Name
Address (City, State, Zip)
Phone
Position Held
From

Month Day Year
Date
To

Month Day Year
Date
Reason for Leaving
May We Contact?

Y N
Were you subject to the FMCR's?

Y N
Was the job as a Safety Sensitive function in any DOT regulated mode subject to drug and alcohol testing as required by 49CFR?

Y N
Company Name
Address (City, State, Zip)
Phone
Position Held
From
To
Reason for Leaving
May we contact?

Y N
Were you subject to the FMCSR's?

Y N
Was the job designated as a Safety Sensitive function in any DOT regulated mode subject to drug and alcohol testing as required by 49CFR part 40?

Y N
Company Name
Address (City, State, Zip)
Phone
Position Held
From
To
Reason for Leaving
May we contact?

Y N
Were you subject to the FMCSR's?

Y N
Was the job designated as a Safety Sensitive function in ant DOT regulated mode subject to drug and alcohol testing as required by 49CFR part 40?

Y N
EDUCATION:
Last school attended (Name, Address) *
Highest Level of Education *
MILITARY STATUS:
Have you served in the military? *

Y N
If yes, what branch?
From
To
ACCIDENTS: (List all accidents or incidents for any vehicle regardless of fault for the past 5 years)
Date

Month Day Year
Date
Fatalities

Non-preventable Over $500 Damage: Under $500
Fatalities
Non-preventable

Cause: Preventable
Explain
Date

Non-preventable Over $500 Damage: Under $500 Cause: Preventable
Date

Month Day Year
Date
Damage: Under $500
Explain
Date

Cause: Preventable Non-preventable Over $500 Damage: Under $500
Date

Month Day Year
Date
Damage: Under $500
Explain
TRAFFIC CONVICTIONS: Traffic Convictions and Forfeitures for the Past 3 Years: (Other than parking violations)
Location
Location
Date

Month Day Year
Date
Charge
Penalty
Location
Date

Month Day Year
Date
Charge
Penalty
Location
Date

Month Day Year
Date
Charge
Penalty
Location
Date

Month Day Year
Date
Charge
Penalty
ALCOHOL AND CONTROLLED SUBSTANCE STATEMENT:

The Federal Motor Carrier Safety Regulations 49CFR 40.25(j) requires all persons applying for a driving position requiring a commercial driver's license to answer the following questions:
1) Within the last three 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, but did not obtain, safety-sensitive transportation work? *

Y N
2) Within the last three 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 performed safety-sensitive transportation work? *

Y N
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? *

Y N
TJS Leasing & Holding Company, Inc., 1850 Murray Road, McKinleyville, CA 95519,T: 707.269.2420,F: 707.269.2424, www.TJSamerica.com
APPLICANT’S STATEMENT:
I, print name *
understand that the information in this Employment

Application will be used and that prior employers will be contacted for purposes of investigation as required by SEC. 391.23 and 49 CFR Part 40.25 FMCSR. I understand that I have the right to review information provided by previous employers and resubmit to TJS Leasing & Holding Co., Inc. a rebuttal statement to erroneous information if a previous company and I cannot agree on the accuracy of the information. I understand that I must request past company information obtained by TJS Leasing & Holding Co., Inc. in writing within 30-days of my application.

Furthermore, I understand there will not be a job offer, any pay, or any reimbursement of funds from TJS Leasing & Holding Co., Inc. until I complete the orientation process including but not limited to; (1) passing a pre-employment drug test, (2) completion of a personal interview, (3) passing a driving test, (4) meet all the legal requirements to drive a commercial truck in the USA, (5) meet the insurance requirements of TJS Leasing & Holding Co., Inc. based upon the sole discretion of the insurance provider and TJS Leasing & Holding Co., Inc.

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN “AT-WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE THE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT IS FURTHER UNDERSTOOD THAT THIS “AT-WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR CONDUCT UNLESS AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION SPECIFICALLY ACKNOWLEDGES SUCH CHANGE IN WRITING.
Signature *

Clear
Date *

Month Day Year
Date
*To be considered for employment as Commercial Driver, applicants are required to provide TJS Leasing Holding Company, Inc. with completed and signed Employment Application containing truthful and accurate information, current DMV driving record (must be original copy, dated within at least 30 daysof Employment Application),copy of your current Driver’s License, and a copy of your current Medical Examiners Certificate at the time of submission of this Employment Application.

TJS Leasing & Holding Company, Inc., 1850 Murray Road, McKinleyville, CA 95519,T: 707.269.2420,F: 707.269.2424, www.TJSamerica.com
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Commercial Driver Application for At-Will Employment

Medical Examiner’s Certificate Expiration

EDUCATION:

MILITARY STATUS:

Location

APPLICANT’S STATEMENT: