KENN TRANSPORT DRIVER APPLICATION

KENN TRANSPORT, 114 JORDAN ST, GRAMBLING LA 71245, 318-394-0836, DISPATCH@KENNTRANSPORT.COM

An Equal Opportunity Employer

COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED.

FIRST NAME

LAST NAME

Phone Number

Please enter a valid phone number.

EMAIL

example@example.com

SOCIAL SECURITY

DATE OF BIRTH

POSITION APPLIED FOR

DATE AVAILABLE FOR WORK

Date

Do you have legal right to work in the United States?

YESNO

Attach additional sheet if more space is needed

	STREET	CITY	STATE	ZIP CODE	# OF YEARS AT ADDRESS
CURRENT
MAILING
PREVIOUS
PREVIOUS
PREVIOUS

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21 I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

CURRENT LICENSE

	STATE	LICENSE NUMBER	TYPE/CLASS	ENDORSEMENTS	EXPIRATION DATE
CURRENT

PREVIOUSLY HELD LICENSE

	STATE	LICENSE NUMBER	TYPE/CLASS	ENDORSEMENTS	EXPIRATION DATE
PREVIOUSLY HELD
PREVIOUSLY HELD

	TYPE OF EQUIPMENT VAN, TANK, FLAT, ETC	DATE FROM	DATE TO	APPROX # OF MILES (TOTAL)
STRAIGHT TRUCK
SEMI-TRAILER
TRACTOR 2 TRAILERS
TRACTOR TANKER
OTHER

ACCIDENT RECORD FORTHE PAST 3 YEARS

Attach additional sheet if more space is needed. Check this box if none

	DATES(List most recent first)	NATURE OF ACCIDENT Head-on, rear-end, upset, etc	FATALITIES	INJURIES	CHEMICAL SPILLS (Y/N)

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS)

Attach additional sheet if more space is needed. Check this box if none

	DATE OF CONVICTION(Month/Year)	VIOLATION	STATE OF VIOLATION	PENALTY (Forfeited bond, collateral and/or points)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YESNO

IF YES, PLEASE EXPLAIN

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

YESNO

IF YES, PLEASE EXPLAIN

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.

Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

CURRENT (MOST RECENT) EMPLOYER

PHONE

ADDRESS

POSITION HELD

FROM (MO/YR)

TO (MO/YR)

REASON FOR LEAVING

SALARY

EXPLAIN ANY GAPS IN EMPLOYMENT (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YESNO

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

YESNO

SECOND (MOST RECENT) EMPLOYER

PHONE

ADDRESS

POSITION HELD

FROM (MO/YR)

TO (MO/YR)

REASON FOR LEAVING

SALARY

EXPLAIN ANY GAPS IN EMPLOYMENT (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YESNO

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

YESNO

THIRD (MOST RECENT) EMPLOYER

PHONE

ADDRESS

POSITION HELD

FROM (MO/YR)

TO (MO/YR)

REASON FOR LEAVING

SALARY

EXPLAIN ANY GAPS IN EMPLOYMENT (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YESNO

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

YESNO

	NAME & LOCATION	COURSE OF STUDY	YEARS COMPLETED	GRADUATE Y/N	DETAILS
High School
College
Other

Please list any other qualifications that you have and which you believe should be considered.

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:
Review information provided by current/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(s) and I cannot agree on the accuracy of the information.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Date

Applicant Name (Typed name serves as electronic signature)

Additonal Information Upload additional documents (optional)

DRIVER EMPLOYMENTAPPLICATION

APPLICANT INFORMATION

PREVIOUS THREE YEARS RESIDENCY

LICENSE INFORMATION

DRIVING EXPERIENCE

EMPLOYMENT HISTORY

EDUCATION

OTHER QUALIFICATIONS

TO BE READ AND SIGNED BY APPLICANT