Truck Driver Application

Position Applying for

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

YesNo

Please list prior 3 year addresses here and please be complete

Date of Birth*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

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

YesNo

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

YesNo

License Class*

License Number*

State of Issue*

License expiration date*

MonthDayYear

Expiration date of DOT physical card

MonthDayYear

CDL Endorsements*

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

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

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name*

City, State*

Employer phone*

Area CodePhone Number

Position Held*

Job Duites

Reason for leaving*

Is this your current employer?*

YesNo

May we contact this employer at this time?*

YesNo

NEXT EMPLOYER

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Job Duites

Reason for leaving

Employer phone

Area CodePhone Number

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Job Duites

Employer phone

Area CodePhone Number

Reason for leaving

Start Date

MonthDayYear

End Date

MonthDayYear

Employer Name

City and State

Position

Job Duites

Employer Phone

Area CodePhone Number

Reason for leaving

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?*

YesNo

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

Applicant must read and sign.

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or its agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not. I hereby release R&R Oilfield services, its officers, employees, agents, directors, affiliates and attorneys and any other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics and mode.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation of omission of information of facts may result in my rejection or dismissal. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant.

If hired, I agree to abide by all the results and policies of my employer.

This certifies 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. This also certifies that I have received a copy of the job description and company policies and all questions have been answered to my satisfaction.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I agree I have read the above statements

Todays Date

MonthDayYear

Number

Employment Application

General Information

License Information

Drivers, you must list a 10 year employment history. There is an open text box below if you need more room to make up your 10 year history. Please be sure to enter all in formation asked for in the employment section, in the open text section.

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Additional Information