SWIPCO Application

SWIPCO Application

SWITA Driver
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Addresses for Past Three Years and How Long*
Have you ever filed an application with us before?*

YesNo
If yes, give date

MonthDayYear
Date
Have you ever been employed with us before?*

YesNo
If yes, give date

MonthDayYear
Date
Are you currently employed?*

YesNo
May we contact your present employer?*

YesNo
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

YesNo
When are you available to start?*

MonthDayYear
Date
Have you ever been convicted of a felony?*

YesNo
If yes, please explain
Have you failed or refused a DOT pre-employment drug test in the previous two years?*

YesNo
If yes, please explain
How did you learn about this position?*

AdvertisementFriend/RelativeEmployment AgencySocial MediaWalk-InOther
Do you have a current CDL (Commercial Driver's License)?*

YesNo
Do you have a current DOT physical?*

YesNo
If yes, when does it expire?
List your driver's licenses (Number and State) and driving experience here.*

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (Attach sheet if more space is needed)

	Dates	Nature of Accident (Head-on, Rear-end, Upset, Etc.)	Fatalities	Injuries
Last Accident
Next Previous
Next Previous

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 5 YEARS (Other than parking violations)

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
If you answered yes to A. or B. above, then give a statement of explanation.
Employment Record
Note: DOT requires that employment for at least 3 years and/or commercial driving experience for the past 10 years be shown.
Last Employer:
Name:blanks
Address:blank
Position Held: blank

Employment Record Note: DOT requires that employment for at least 3 years and/or commercial driving experience for the past 10 years be shown.*

Day and Shift Availability*

Availability Section