Employment Application

  • Date Format: MM slash DD slash YYYY
  • Addresses for the past 3 years

  • REFERENCES

    List three references who know you.
  • Submit verification of your identity and authorization to work in the United States. Do you have any restrictions or time limitations on your eligibility to work in the United States?
  • DOT REGULATIONS REQUIRE ALL DRIVERS TO BE ABLE TO SPEAK, READ AND WRITE THE ENGLISH LANGUAGE.
  • DRIVER LICENSES

  • Date Format: MM slash DD slash YYYY
    Expiration Date
  • Date Format: MM slash DD slash YYYY
    Expiration Date
  • Date Format: MM slash DD slash YYYY
    Expiration Date
  • (If more space is needed please attach an additional sheet and a copy of both sides of driver's license)
  • A. Have you ever been deed a license, permit, or privelege to operate a motor vehicle?
  • B. Has any license, permit, or privilege ever been suspected or revoked?
  • If the answer to either A or B is YES, attach a statement giving details.
  • DRIVING EXPERIENCE

  • Class of Equipment

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • ACCIDENT RECORD FOR PAST 3 YEARS

  • TRAFFIC CONVICTIONS FOR PAST 3 YEARS

    (OTHER THAN PARKING VIOLATIONS)
  • (If more space is needed please attach an additional sheet)
  • EMPLOYMENT RECORD

    NOTE: Show all employment for the past three years and all commercial driving experience for the past 10 years.
  • Entry 1

  • Position
  • Date Format: MM slash DD slash YYYY
    From
  • Date Format: MM slash DD slash YYYY
    To
  • Reason for leaving
  • (Federal Motor Carrier Safety Regulations)
  • Subject to drug/alcohol testing requirements per 49 CFR part 40?
  • Entry 2

  • Position
  • Date Format: MM slash DD slash YYYY
    From
  • Date Format: MM slash DD slash YYYY
    To
  • Reason for leaving
  • (Federal Motor Carrier Safety Regulations)
  • Subject to drug/alcohol testing requirements per 49 CFR part 40?
  • Entry 3

  • Position
  • Date Format: MM slash DD slash YYYY
    From
  • Date Format: MM slash DD slash YYYY
    To
  • Reason for leaving
  • (Federal Motor Carrier Safety Regulations)
  • Subject to drug/alcohol testing requirements per 49 CFR part 40?
  • (Please attach additional sheets if neccessary)
  • As a prospective employer, we must ask any applicant for a driving position with our company whether he/she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applied for, but did not obtain, "safety-sensitive transportation work" (driving a commercial motor vehicle) during these past three years.
  • Have you been tested positive for drugs/alcohol or refused to take a pre-employment drug alcohol test in the three years preceding the date of this application?
  • DOT regulations prohibit our utilizing you to perform a "safety-sensitive function" (driving a commercial motor vehicle). If you had a positive test, or a refusal to test, until and unless you provide documents showing successful completion of the return-to-duty process in accordance with DOT regulations.
  • Please attach any additional documents required.
    Drop files here or
  • TO BE READ AND SIGNED BY THE APPLICANT

    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.
  • Date Format: MM slash DD slash YYYY