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  • EMPLOYMENT APPLICATION

    An Equal Opportunity Employer

  • Please fill out all sections. Only complete applications will be considered.

  • APPLICANT INFORMATION

  • Format: (000) 000-0000.
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of Application
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date Available for Work
     - -
    2 digit month, 2 digit day, 4 digit year
  • PREVIOUS THREE YEARS RESIDENCY
    Rows

  • LICENSE INFORMATION

  • 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.
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  • DRIVING EXPERIENCE
    Rows
  • ACCIDENT RECORD FOR THE PAST 3 YEARS
    Rows
  • TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)
    Rows
  • Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
  • Has any license, permit, or privilege ever been suspended or revoked?
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  • 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. Start with the last or current position, including any military experience, and work backwards. You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information
  • Are you now employed?
  • Have you worked for this company before?
  • CURRENT (MOST RECENT) EMPLOYER
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  • SECOND (MOST RECENT) EMPLOYER
    Rows
  • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
  • 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?
  • THIRD (MOST RECENT) EMPLOYER
    Rows
  • FOURTH (MOST RECENT) EMPLOYER
    Rows
  • FIFTH (MOST RECENT) EMPLOYER
    Rows
  • EDUCATION
    Rows
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  • TO BE READ AND SIGNED BY APPLICANT:

    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
     - -
    2 digit month, 2 digit day, 4 digit year

  • MVR Authorization

    Motor Vehicle Record consent

  • AUTHORIZATION TO OBTAIN MOTOR VEHICLE RECORD

    If license issued less than 3 years ago, provide prior state and license number for a 3-year history.
  • DATE OF BIRTH
     - -
    2 digit month, 2 digit day, 4 digit year

  • EMPLOYER INFORMATION:
    PACE FIELD SERVICES, LLC
    4060 FAUDREE RD. STE 104A #219
    ODESSA, TEXAS 79765

    Dear Employer:
    As part of the company’s evaluation of my job application and/or employment, I understand that consumer reports may be obtained. These reports may include, but are not limited to, information such as my driving record, an assessment of my insurability under the company’s insurance policies, or other relevant consumer data.

     
    By signing this disclosure, I authorize the company to obtain such reports now and, if necessary, at any point during my employment for purposes related to insurability or other lawful employment considerations.
    Sincerely,

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: