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Driver Application
We look forward to being of service.
Please complete this secure form, and we will contact you within the next business day
Driver Employment Form
Your Personal Information
Name
First Name
last Name
Home Phone
Cell Phone
Current Address
Position Applying For
Period of job
Temporary
Full time
Part time
Who Referred You
Rate of Pay Expected
Are you currently employed
Yes
No
If not, how long since leaving last employment
Date of Birth
MM slash DD slash YYYY
Social Security Number
DRIVER'S LICENSE INFORMATION
Driver Licenses held in the past 3 years must be shown
State
License Number
Type
Expiration Date
Add
Remove
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
B. Has any license, permit or privilege ever been suspended or revoked?
Yes
No
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations
Yes
No
If you answered 'YES' to A, B, or C, write a statement below giving details
DRIVING EXPERIENCE
Class of Equipment
Straight Truck
Tractor and Semi-Trailer
Twin
Other
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Type of Equipment
Dates
Approximate Total Miles
Add
Remove
EMPLOYMENT RECORD
The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven 97) years for a total of ten (10) years. Any gaps in employment must be explained. Start with the last or current position, including any military experience, and work back. You are required to list hte complete mailing address: street number, city, state and zip code.
Previous Employer
Supervisor's Name
Address
Position Held
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Salary
Reason for leaving
APPLICANT MUST READ AND CHECK BOX
I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herin from all liability for any damages on account of his 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.
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, personal reputation, personal characteristics and mode of living.
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 or omission of information or facts may result in my rejection or dismissal.
If hired, I agree to abide by all the rules and policies of the employer.
This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.
I agree to the privacy policy.
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