Driver Inc Job Application Form

Pre-Employment Application

Please complete the form below to apply for a position with us.
APPLICANT INFORMATION
Full Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
Available Start Date

MonthDayYear
Social Security No.
Desired Salary $
Position Applied for:
Are you authorized to work in the U.S.
Do you have a Commercial Driver License?
Have you ever been convicted of a felony?
If Yes, explain:
Education
High School
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?
Diploma
College
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?
Degree
Other
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?
Degree
Current/Previous Employment
Previous Company #1
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason for leaving
Previous Company #2
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason for leaving
May we contact your previous employer?
Job Requirement Questions
Can you pass a DOT medical physical?*

YesNo
Can you pass a DOT Drug test?*

YesNo
Will you be able to work on a safety sensitive job site?*

YesNo
Will you be able to work out of town and away from home?*

YesNo
Will you be able to work 12-14 hour daily when needed?*

YesNo
Will you be able to be on an on-call rotation to work weekends & holidays?*

YesNo
Disclaimer and Signature
Have you 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 covered by USDOT agency drug and alcohol testing rules during the past 2 years?
If you answered yes, can you provide proof that you have successfully completed the DOT return-to-duty requirements?
Has any license, permit, or privilege to operate a motor vehicle been suspended or revoked?
If yes, explain:
- I give permission for a 3 year driving record to be obtained by this company.
- I certify that my answers are true and complete to the best of my knowledge.
- I understand this is a preliminary application and further information will be needed if I am offered a position.
- I understand the answers on this application do not automatically disqualify me from a position with this company.
- If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature*

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Pre-Employment Application

APPLICANT INFORMATION

Education

Current/Previous Employment

Job Requirement Questions

Disclaimer and Signature