Allwaste Industrial Services, LLC

Allwaste Industrial Services, LLC

(346) 801-3116 | jobs@allwasteindustrial.com
Commercial Driver Application
Application Date

MonthDayYear
Date
Date Available for Work

MonthDayYear
Date
Name

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

MonthDayYear
Date
Social Security Number
Do you have the right to work in the United States?*

YesNo
Where have you lived for the last three years?
Current Address

Street Address

Street Address Line 2

CityState

Postal Zip Code
Number of Years at Current Address
Is your mailing address the same as your current home address?

YesNoOther
Mailing Address

Street Address

Street Address Line 2

CityState

Postal Zip Code
Previous Address

Street Address

Street Address Line 2

CityState

Postal Zip Code
Number of Years at Previous Address
Previous Address

Street Address

Street Address Line 2

CityState

Postal Zip Code
Number of Years at Previous Address
Previous Address

Street Address

Street Address Line 2

CityState

Postal Zip Code
Number of Years at Previous Address
License Information

49 CFR 383.21 - No person who operates a commercial motor vehicle shall at any time have more than one driver's license. I certify that I do not have more than one motor vehicle license, the information for which is listed below:
State
License Number
Type Class
Endorsements

(H): Hazardous Materials(N): Tank Vehicles(T): Double/Triple Trailers(X): Combination of Tank Vehicle and Hazardous Materials
Expiration Date

MonthDayYear
Date
Previously Held Licenses

Leave this section blank if not applicable.
State
License Number
Type Class
Endorsements

(H): Hazardous Materials(N): Tank Vehicles(T): Double/Triple Trailers(X): Combination of Tank Vehicle and Hazardous Materials
Expiration Date

MonthDayYear
Date
Previously Held Licenses

Leave this section blank if not applicable.
State
License Number
Type Class
Endorsements

(H): Hazardous Materials(N): Tank Vehicles(T): Double/Triple Trailers(X): Combination of Tank Vehicle and Hazardous Materials
Expiration Date

MonthDayYear
Date
Driving Experience
Class of Equipment
Type of Equipment (Van, Tank, Flatbed, etc.)
Beginning Date
Ending Date
Approximate Number of Miles Driven
Class of Equipment
Type of Equipment (Van, Tank, Flatbed, etc.)
Beginning Date
Ending Date
Approximate Number of Miles Driven
Class of Equipment
Type of Equipment (Van, Tank, Flatbed, etc.)
Beginning Date
Ending Date
Approximate Number of Miles Driven
Class of Equipment
Type of Equipment (Van, Tank, Flatbed, etc.)
Beginning Date
Ending Date
Approximate Number of Miles Driven
Class of Equipment
Type of Equipment (Van, Tank, Flatbed, etc.)
Beginning Date
Ending Date
Approximate Number of Miles Driven
Accident Record for the Last 3 Years

List beginning with the most recent incident. Skip this field if it is not applicable.
Date
(Month/Year)
Nature of Accident
Number of Fatalities
Number of Injuries
Any vehicle towed away?

YesNoOther
Chemical Spills?

YesNoOther
Date
(Month/Year)
Nature of Accident
Number of Fatalities
Number of Injuries
Any vehicle towed away?

YesNoOther
Chemical Spills?

YesNoOther
Date
(Month/Year)
Nature of Accident
Number of Fatalities
Number of Injuries
Any vehicle towed away?

YesNoOther
Chemical Spills?

YesNoOther
Traffic Convictions and Forfeitures for the Past 3 Years

Other than traffic violations. Skip this field if it is not applicable.
Date
(Month/Year)
Violation
State of Violation
Penalty

ForfeitureBondDriving PointsOther
Date
(Month/Year)
Violation
State of Violation
Penalty

ForfeitureBondDriving PointsOther
Date
(Month/Year)
Violation
State of Violation
Penalty

ForfeitureBondDriving PointsOther
Date
(Month/Year)
Violation
State of Violation
Penalty

ForfeitureBondDriving PointsOther
Denials, Revocations, Suspensions
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YesNo
If yes, explain:
Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require all applicants wishing to drive a commercial vehicle to list their employment history for the past three years. In addition, if you have previously driven a commercial vehicle, you must provide your employment history for an additional seven years (10 years total). Any gaps in employment exceeding one month must be explained.
Most Recent Employer Phone Number Street Address Address Line 2 City State Zip
Position held
Employment period
(MM/YYYY - MM/YYYY)
Reason for leaving
Explain any gaps in employment
Include month/year and reason
While employed here, did you drive a vehicle that required you to have a CDL (subject to US DOT FMCSR)?

YesNo
Did your work involve working on a pipeline right-of-way, or facility subject to drug/alcohol testing under US DOT (49 CFR 40)

YesNo
2nd Most Recent Employer Phone Number Street Address Address Line 2 City State Zip
Position held
Employment period
(MM/YYYY - MM/YYYY)
Reason for leaving
Explain any gaps in employment
Include month/year and reason
While employed here, did you drive a vehicle that required you to have a CDL (subject to US DOT FMCSR)?

YesNo
Did your work involve working on a pipeline right-of-way, or facility subject to drug/alcohol testing under US DOT (49 CFR 40)

YesNo
3rd Most Recent Employer Phone Number Street Address Address Line 2 City State Zip
Position held
Employment period
(MM/YYYY - MM/YYYY)
Reason for leaving
Explain any gaps in employment
Include month/year and reason
While employed here, did you drive a vehicle that required you to have a CDL (subject to US DOT FMCSR)?

YesNo
Did your work involve working on a pipeline right-of-way, or facility subject to drug/alcohol testing under US DOT (49 CFR 40)

YesNo
Education

	Institution Name	Address	Years Completed	Did you Graduate?	Details
High School
College
Other

Other Qualifications
Please list any other qualifications that you have and which you believe should be considered.
Authorization for Investigation:

I authorize Allwaste Industrial Services, LLC to investigate my personal, employment, financial, and medical history, motor vehicle driving record, and other relevant matters as necessary for making an employment decision. I release all previous employers, educational institutions, healthcare providers, and other individuals from liability in responding to inquiries and providing information related to my application.

False or Misleading Information:

I understand that providing false or misleading information in my application or during interviews may result in termination of employment. I agree to abide by all rules and regulations of Allwaste Industrial Services, LLC if employed.

Resignation Within 90 Days of Hire:

If I voluntarily resign from Allwaste Industrial Services, LLC or am discharged for cause within 90 days of my hire date, I acknowledge that the costs incurred by the company for my training, drug testing, and medical evaluations may be deducted from my final paycheck.

Information Sharing and Verification:

I understand that the information I provide regarding my current and previous employers may be used and that these employers will be contacted to verify my safety performance history, as required by 49 CFR 391.23. I acknowledge that I have the following rights:
- To review the information provided by my current and previous employers.
- To have any errors in this information corrected by those employers and for them to resend the corrected information to Allwaste Industrial Services, LLC.
- To attach a rebuttal statement to any alleged erroneous information if I and the previous employers cannot agree on its accuracy.
Certification:

I certify that all the information I have provided in this application is true and accurate 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.
Applicant Signature

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Signature Date

MonthDayYear
Date
File Upload

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