Employment Application | Claiborne Hauling, LLC

EMPLOYMENT APPLICATION

First

Last

Email*

Date

Phone

Company name:

Number of years employed?

Position Held

Salary/Wage

Reason For Leaving

Contact Person

Employer's phone number:

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Duties:

Were you subject to the FMCSRs while employed?*

YesNo

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commence to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.)

Was your job designated as a safety sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

YesNo

Company name:

Number of years employed?

Position Held

Salary/Wage

Reason For Leaving

Contact Person

Employer's phone number:

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Duties:

Were you subject to the FMCSRs while employed?*

YesNo

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commence to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.)

Was your job designated as a safety sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

YesNo

Company name:

Number of years employed?

Position Held

Salary/Wage

Reason For Leaving

Contact Person

Employer's phone number:

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Duties:

Were you subject to the FMCSRs while employed?*

YesNo

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commence to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.)

Was your job designated as a safety sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

YesNo

Company name:

Number of years employed?

Position Held

Salary/Wage

Reason For Leaving

Contact Person

Employer's phone number:

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Duties:

Were you subject to the FMCSRs while employed?*

YesNo

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commence to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.)

Was your job designated as a safety sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

YesNo

EDUCATION

Choose Your Level of Education*

Last School Attended*

Driving Record
Provide Info for Past Three Years. If none, write NONE.

Accidents

Date of Accident

Nature of Accident (Head-on, Rear-end, Upset, Etc.)

Fatalities

Injuries

Hazardous Material Spill

Date of Accident

Nature of Accident (Head-on, Rear-end, Upset, Etc.)

Fatalities

Injuries

Hazardous Material Spill

Date of Accident

Nature of Accident (Head-on, Rear-end, Upset, Etc.)

Fatalities

Injuries

Hazardous Material Spill

Traffic Convictions*

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

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

YesNo

Have any license, permit, or privilege ever been suspended or revoked?**

YesNo

If yes, provide details:

Employment Details

CDL Driving Experience

Class of Equipment: (Straight Truck, Tractor & Semi-Trailer, Tractor - Two Trailers, Motorcoach - School Bus)

Type of Equipment: (Van, Tank, Flat, Etc.)

Dates (From):

Dates (To):*

Class of Equipment: (Straight Truck, Tractor & Semi-Trailer, Tractor - Two Trailers, Motorcoach - School Bus)

Type of Equipment: (Van, Tank, Flat, Etc.)

Dates (From):

Dates (To):*

Class of Equipment: (Straight Truck, Tractor & Semi-Trailer, Tractor - Two Trailers, Motorcoach - School Bus)

Type of Equipment: (Van, Tank, Flat, Etc.)

Dates (From):

Dates (To):*

List States Opearated In for Last Five Years:

Show Special Courses or Training that Will Help You as a Driver:

Which Safe Driving Awards Do You Hold and from Whom?

Show Any Trucking, Transportation, or Other Experience That May Help In Your Work For This Company:

List Courses and Training Other Than Shown Elsewhere in this Application:

List Special Equipment or Technical Materials You Can Work With (Other Than Already Shown)

How many years of experience do you have driving a dump truck?

Do you have any experience moving heavy equipment?

YesNo

Do you have a current CDL?

YesNo

How many years have you had a CDL?

Yes

No

Can you operate grading equipment if so how many years experience do you have operating grading equipment?

Driver's License Type (DL/CDL)

Class

Endorsements

Restrictions

Equipment Operation
List which (if any) of the following equipment that you can operate. Also describe, on a 1 to 5 scale how comfortable you are with handling each unit, with 5 being the most advanced.

List all equipment you can you operate and how comfortable you are operating it:

Have you ever driven a flat bed? If so, what equipment have you hauled?

Have you ever driven a low boy? What equipment have you hauled?

Have you ever pulled a tilt top trailer? What equipment have you hauled?

As the opportunity comes up, would you be interested in working:

Nights

Weekends

Out of town

All of the above

None of the above

Nights & Weekends

Weekends & Out of town

Nights & Out of town

Position desired?

LowBoy

Dumptruck

Operator

How much LowBoy experience do you have?

Have you ever moved multiple pieces of equipment on a LowBoy?

Have you used Dump Trailers?

Have you used Hydraulic Detachable LowBoys?

Have you used Tilt Tops?

Have you moved equipment over 70,000 lbs.?

Can you load different styles of equipment such as: Dozers, Trackhoes, Loaders, Fork Lifts, Crawlers, etc.?

Have you ever operated a rail trailer?

Do you know how to chain and bind loads, equipment? Explain:

Are you familiar with load limits? If so, explain:

What is a superload?

What are three (3) things you should do before starting your truck?

Why do you want to be employed by Claiborne Heavy Hauling?

What do you think makes a good place to work?

How much dump truck experience do you have?

What types of aggregate have you hauled?

What is a safe following distance in a loaded dump truck?

How often should you check you mirrors while driving?

Name three things you should check on your truck before driving it.

Backhoe

Is there any certain piece of equipment you specialize in operating?

Is there anything additional that you would like for us to know about your work experience?

Comments

EMPLOYMENT APPLICATION

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