Commercial Driver Application

Commercial Driver Application

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.
Date of Application*

MonthDayYear
Date
Applying for Position*
Personal Information
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Social Security Number*
Must contain 9 digits
Are you legally authorized to work in the United States?*

YesNo
Previous Three Years Residency
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
From*

MonthDayYear
Date
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date

Resume

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File Upload

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Paste Text Here

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.
Are you currently employed?*

YesNo
Current (Most Recent) Employer

Name

Street Address

CityState

Phone Number
Email address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Reason for Leaving
Please explain any gaps in employment
Second (Most Recent) Employer

Name

Street Address

CityState

Phone Number
Email Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Reasons for leaving
Please explain any gaps in employment
Third (Most Recent) Employer

Name

Street Address

CityState

Phone Number
Email Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Reason for leaving
Please explain any gaps in employment
Fourth (Most Recent) Employer

Name

Street Address

CityState

Phone Number
Email address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Reason for leaving
Please explain any gaps in employment
Fifth (Most Recent) Employer

Name

Street Address

CityState

Phone Number
Email Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Position held
Reason for leaving
Please explain any gaps in employment

Education and Other Qualifications

Education

	Name and Location	Course of Study	Years Completed
High School
College
Other

Other Qualifications
Please list any other qualifications which you believe should be considered.
How did you find out about JASKO Enterprises, Inc?
Company WebsiteCraigslist AdYoutubeFacebookEmployee ReferralOther
Please enter the full name of referral
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 inter- view(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 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*

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