Position(s) Applied for        Date

Name          

Social Security #      Phone Number

Current Address  

Previous Addresses for the past three years:

Address 1   

Address 2   

Address 3   

Date of Birth      Can you provide proof of age?

Is there any reason you might be unable to perform the functions of the job for which you are applying?

If Yes, Enter explanation here if you wish.

Have you ever filed an application with us before?      If Yes, give date 

Have you ever been employed with us before?      If Yes, give date 

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?  (Proof of citizenship or immigration status will be required upon employment) 

On what date would you be available for work?

Are you available to work: Full Time     Part Time     Temporary

Hours Available

Are you currently on "layoff" status and subject to recall?

Have you ever been convicted of, or admitted guilt (including suspended, expunged, and/or deferred sentences) to any crime involving dishonesty or breach of trust?

If yes, please enter explanation here.

Employment Experience

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years.  Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicles.

NOTE:  List employers in reverse order starting with the most recent.  You may provide additional employers in the comments field at the end of the application if they will not all fit in the area below.

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in quantity requiring placarding.

Employer

Name      Dates Employed From   To

Address

Contact Person   Phone Number

Position      Wage

Reason for Leaving

Employer

Name      Dates Employed From   To

Address

Contact Person   Phone Number

Position      Wage

Reason for Leaving

Employer

Name      Dates Employed From   To

Address

Contact Person   Phone Number

Position      Wage

Reason for Leaving

Employer

Name      Dates Employed From   To

Address

Contact Person   Phone Number

Position      Wage

Reason for Leaving

Employer

Name      Dates Employed From   To

Address

Contact Person   Phone Number

Position      Wage

Reason for Leaving

Driving Experience & Qualifications

Accident Record for past 3 years or more

Use additional comments section at the end of application if more room is needed

Last Accident     

Next Previous     

Next Previous     

Next Previous     

Select Highest Grade Completed 1 2 3 4 5 6 7 8 9 10 11 12 College 1 College 2 College 3 College 4

Last School Attended   

Traffic Convictions and Forfeitures for the past 3 years

Not including parking violations

Experiences and Qualifications - Drivers Licenses

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

If yes, explaine here.

Has any license, permit or privilege ever been suspended or revoked? 

If yes, explaine here

Driving Experience

Straight Truck                    

Tractor & Semi-Trailer       

Tractor - Two Trailer         

Other                                

List States operated in for the last 5 years 

Which safe driving awards do you hold and from whom? 

Other Experience and Qualifications

Show any trucking, transportation or other experience that may help in your work for this company

List any courses and training that will help you as a driver

List special equipment or Technical materials you can work with other than those already shown

Additional Comments

To be read before submitting application

     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.

     I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision as required by 49CFR301.23.  (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)  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 understand, also, that I am required to abide by all rules and regulations of the company.

     I understand this application is not a contract of employment and that in the event I am employed, I may, with or without notice, at any time, voluntarily terminate my employment.  I further understand that I may be terminated involuntarily by the employer at will, with or without cause.  Any oral statements or promises by the employer or its agents are hereby expressly disavowed and may not be relied upon by an employee.