Driver Application Form

  • Employment Application Form:

  • Personal Information

    Please enter your Personal Information. When you have finished, select "Next" to continue to the next section of the application.
  • Format: (000) 000-0000.
  • Date of Birth*
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  • DRIVING RECORD & EXPERIENCE

    Please answer the following questions thruthfully
  • License Expiration Date*
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  • Whay type License do you have (check all that apply):*

  • Under the Violations section:

    If you have not had any violations in the past 10 years, type N/A. Please be honest as we conduct full background and Motor Vehicle Reports. Violations do not remove you from possible employment.

     

    Under Towing Experience Section: 

    Please type N/A for items you do not have experience with. Use the additional blank rows to add other towing experience that is not already written.

  • Do you have your own Reliable truck?
  • Do you have your own 5th wheel hitch?*
  • Have you driven a Motorhome less than 30 Ft?*
  • Have you driven a Motorhome greater than 30 Ft?*
  • Have you ever been denied a licensed, permit or privilege to operate a motor vehicle?*
  • Has any license, permit or privilege ever been suspended or revoked?*

  • Employment History

    Please enter the information requested for your work experience. Press "Submit" when you have finished. Complete 10 years of Employment history OR complete current employer and upload previous 10 year history in the upload file section at the bottom of the page.
  • Years of Driving Experience Towing*
  • Employment Start Date*
     - -
  • Employment End Date
     - -
  • May we contact?*
  • Accident Details
  • Employment Start Date*
     - -
  • Employment End Date
     - -
  • May we contact?*
  • Accident Details
  • Employment Start Date*
     - -
  • Employment End Date
     - -
  • May we contact?*
  • Accident Details
  • Employment Start Date*
     - -
  • Employment End Date
     - -
  • May we contact?
  • Accident Details
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof

  • References

    List 3 References.

  • References:

  • Send Application:

  • By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.  

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.  

    I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.  

    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 unemployment 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 employment.

    In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Kims Cozy Campers.

    I understand that information I provide regarding current and/or previous employers may be used, and those employers 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 the previous employers;
    • Have errors in the information corrected by previous employers and for those previous employers to resend the corrected information to the prospective employer; and
    • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information.

     

  • Date*
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  • Should be Empty: