Truck Driver Application

DRIVER APPLICATION

Thank you for your interest in Union Coverage Group. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

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 status.

Required entry fields are followed by, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at 908-663-8667.

Requirements:

To qualify with Union Coverage Group, you must meet the following criteria:

Valid commercial license with proper endorsements in the state of residence:

-Work permit is not acceptable

-A minimum of One and Half (1.5) years verifiable over the road experience

-No serious** or disqualifying traffic violations within the last three (3) years

-Excessive speeding, 15 mph over the posted speed limit

-Reckless driving

-Improper or erratic lane changes

-Following too close

-Hit and run

-No more than three (3) moving violations in the past three (3) years

-No more than one (1) moving violations in the past twelve (12) months

-Only one (1) DOT reportable accident within the past three (3) years

-No convictions for DWI for the past ten (10) years

-No positive results for a controlled substance

-No convictions for use, sale, or possession of any controlled substance

Position/Lane Applying For

Owner Operator Company name

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Were you at this address 3 years or more

Please list prior 3 year addresses here and please be complete

Date of Birth

MonthDayYear

Phone Number

Format: 0000-00000.

E-mail

example@example.com

Have you ever been known by any other name?

Please list name

Explain ie; maiden name, name change

If hired, can you furnish proof you are eligible to work in the U.S.?

Are you at least 23 years of age or older?

Have you held a VALID US license for the past 36 months?

License Class

License Number

State of Issue

License expiration date

MonthDayYear

Expiration date of DOT physical card

MonthDayYear

CDL Endorsements

Hazmat expiration date

MonthDayYear

TWIC expiration date

MonthDayYear

Please list any licenses held in other states for the previous 5 years, include license numbers if you can.

Were you ever in the military?

Branch of service

Please list Dates of enlisment

Enlist date - Discharge date

Did you receive an honorable discharge?

Do you have, or can you obtain your DD214?

Have you been to truck driving school?

School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry

School phone number

Format: 0000-00000.

Did you graduate?

Work History: Please list current, or most recent employment first

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Employer phone

Format: 0000-00000.

Position Held

Reason for leaving

Is this your current employer?

May we contact this employer at this time?

Was this a driving position?

Type of truck

Type of trailer

Trailer length

Number of states driven

NEXT EMPLOYER

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Reason for leaving

Employer phone

Format: 0000-00000.

Was this a driving position?

Type of truck

Type of trailer

Trailer length

Number of states driven

NEXT EMPLOYER

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Employer phone

Format: 0000-00000.

Reason for leaving

Was this a driving position

Type of truck driven

Type of trailer

Trailer length

Number of states driven

Start Date

MonthDayYear

End Date

MonthDayYear

Employer Name

City and State

Position

Employer Phone

Format: (000) 000-0000.

Reason for leaving

Was this a driving position

Type of truck driven

Type of trailer

Trailer length

Number of states driven

If you need additional space for past employment, please enter it here and include ALL information previously asked for.

Have you had any moving violations in the last 5 years?

If yes, please list City, County and State, month, year and nature of offense and any fines involved

Please list miles over limit for speeding

Has your license ever been suspended?

If yes, please give date and length of supension. List reason why, city, county and state

List all details asked for

Have you had any accidents in the last 5 years?

If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)

Have you ever had a DUI, DWI, or OVI?

If yes, please list date of offense, jail time, fine and or suspension time.

We must have complete information to satisfy isusance carrier requirements.

Have you ever been convicted of a felony?

If yes, please give date and nature of offense, city, county, state and any fines and time served

Please list EVERYTHING asked for per isurance requirements

Have you ever been convicted of a misdemeanor?

If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines

Please list EVERYTHING asked for

Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: 0000-00000.

Number of years known

Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: 0000-00000.

Number of years known

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Relationship to you

Phone Number

Format: (000) 000-0000.

HIGH SCHOOL

Name & City/State of High School

Did you graduate?

By signing I agree I have read the above statements

For driver applicants of commercial motor vehicles that require a Commercial Driver License (CDL) the applicant must disclose their controlled substance and alcohol status per the requirements of 49 CFR part 40.25(j).

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re-send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective emp loyer, which may be done at anytime, including when applying or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.

Certification

“I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.”

Date

Signature

License Information

EMPLOYMENT HISTORY

Additional Information

Additional Information

References: Please list name, address, phone and years known.

Emergency contact information