Driver Application

242 US HWY 70 W Havelock, NC 28532 - 5226 Narron Business Dr. Morehead City, NC 28557 - 170 Woods Circle New Bern, NC 28562
(252) 447-3241 Office - (252) 447-3241 Fax - dispatch@graystowing.net

Driver Application
Personal Information
Full Name

First NameMiddle NameLast NameSuffix
Present Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Have you lived at this address for more than 3 years?

YesNo
List address history for past 3 years:
Date of Birth*

MonthDayYear
Social Security Number*
***-**-****
Phone Number*
***-***-****
E-mail*
example@example.com
List any additional names you may have used:
Example: maiden name, name change, nicknames
Driver Position Applying For: (more than one may be selected)*

Wrecker/ Wheel liftRollbackHeavy OperatorRoadside Service Technician
Available Start Date*

MonthDayYear
Date
Availability*

Full-Time - Day and NightFull-Time - Day OnlyPart-Time - Day and NightPart-Time - Day DayPart-Time - Night OnlySpecific Availability (explain)
Are you eligible to work in the U.S.?*

YesNo
Are you at least 21 years of age or older?*

YesNo
Do you have personal automobile insurance?*

YesNo
Do you have a current and active Driver's License?*

YesNo
License Number*
State of Issue*
License expiration date*

MonthDayYear
License Class*
Medical Card expiration date (if applicable)

MonthDayYear
CDL Endorsements*

NoneTankerDoubles/TriplesHazmatX EndorsementTWIC
Hazmat expiration date (if applicable)

MonthDayYear
TWIC expiration date (if applicable)

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

YesNo
Please list date, offense/conviction, city/state, commercial or personal vehicle, and any related comments.
Has your license ever been denied, revoked, or suspended?*

YesNo
Please list date, offense, city/state, and any related comments.
Have you had any accidents in the last 5 years?*

YesNo
Please list date, nature of accident, tickets recieved, commercial or personal vehicle, and city/state of incident.
Have you ever been convicted of a felony?*

YesNo
Please list date, offense/conviction, city/state, and any related comments.
Have you ever been convicted of a misdemeanor?*

YesNo
Please list date, offense/convicition, city/state, and any related comments.
Have you ever had a DUI, DWI, or OVI?*

YesNo
Please list date, offense/conviction, city/state, and any related comments.
Were you ever in the military?*

YesNo
Branch of service
Please list dates enlisted
Enlist date - Discharge date
Did you receive an honorable discharge?

YesNoOther
Do you have, or can you obtain your DD214?

YesNoI can obtain one
EMPLOYMENT HISTORY
List current or most recent employment first.

Non-CDL driver applicants must provide 3 years employment history. CDL driver must provide 10 years employment history. This may be used, and your prior employers may be contacted, for the purpose of investigating your background as required by 49 CFR §391.23.
Have you ever worked for this company before?*

YesNo
Do you have any friends or relatives working here?*

YesNo
Have you ever been terminated or resigned from any job*

YesNo
Do you have any commitments to any other employer which may affect your employment here?*

YesNo
Start date*

MonthDayYear
Ending date*

MonthDayYear
Employer Name*
City, State*
Employer Phone*
***-***-****
Position Held*
May we contact this employer?*

YesNo
Is this your current employer?*

YesNo
Job Description*
Reason for leaving*
PREVIOUS EMPLOYER
Start date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Employer Phone
***-***-****
Position Held
Job Description
Reason for leaving
PREVIOUS EMPLOYER
Starting date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Employer Phone
***-***-****
Position Held
Job Description
Reason for leaving
PREVIOUS EMPLOYER
Start Date

MonthDayYear
End Date

MonthDayYear
Employer Name
City and State
Employer Phone
***-***-****
Position
Job Description
Reason for leaving
If you need additional space for past employment, please enter it here and include ALL information previously asked for.
EDUCATION & SKILLS
Name and City/State of High School
Name and City/State of College (if applicable)
Please select education level completed:
Please list any additional job related experience:
By signing, I agree I have read the above statements: *
Should be Empty:

242 US HWY 70 W Havelock, NC 28532 - 5226 Narron Business Dr. Morehead City, NC 28557 - 170 Woods Circle New Bern, NC 28562 (252) 447-3241 Office - (252) 447-3241 Fax - dispatch@graystowing.net

Personal Information

EMPLOYMENT HISTORY

EDUCATION & SKILLS

242 US HWY 70 W Havelock, NC 28532 - 5226 Narron Business Dr. Morehead City, NC 28557 - 170 Woods Circle New Bern, NC 28562
(252) 447-3241 Office - (252) 447-3241 Fax - dispatch@graystowing.net