DRIVER EMPLOYMENT APPLICATION

In compliance with Federal and State equal employment opportunities laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.


    TO BE READ AND SIGNED BY APPLICANT

    I authorize you to make such investigations and inquiries of my personal, employment, financial or medial history and other related matters as may be necessary in arriving at an employment decision. (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 personal 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 that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

    * Review information provided by previous employers;

    * Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

    * Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.


    Application To Complete

    ( Answer all questions )


    List your addresses for the past 3 years.

    Current Address

    Previous Address 1

    Previous Address 2


    Do you have the legal right to work in the United States?

    Date of Birth (Required for Commercial Drivers)

    Can you provide proof of age?

    Have you worked for this company before? Where? Dates: From to Rate of Pay: Position: Reason for Leaving:

    Are you now employed?

    If not, how long since leaving last employment?

    Who referred you?

    Rate of pay expected:

    Have you ever been bonded? (Answer only if a job requirement)

    Name of bonding company:

    Have you ever been convicted of a felony?

    If yes, please explain. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered.

    Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

    If yes, explain if you wish:


    EMPLOYMENT HISTORY

    All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. 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 vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)


    Employer 1

    Name: Address: Phone: Contact Person: Dates From and To: Were you subject to the FMCRs While Employed? 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? Position Held: Salary/Wage: Reason For Leaving:


    Employer 2

    Name: Address: Phone: Contact Person: Dates From and To: Were you subject to the FMCRs While Employed? 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? Position Held: Salary/Wage: Reason For Leaving:


    *Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in the quantity requiring placarding. ^The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,0001 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.


    ACCIDENT RECORD

    For past 3 years or more (attach sheet if more space is required). If none, write none.

    Accident 1 Date: Nature of Accident: Fatalities: Injuries: Hazardous Material Spill:

    Accident 2 Date: Nature of Accident: Fatalities: Injuries: Hazardous Material Spill:

    Accident 3 Date: Nature of Accident: Fatalities: Injuries: Hazardous Material Spill:

    TRAFFIC CONVICTIONSand forfeitures for the past 3 years (other than parking violations). Traffic Convictions 1 Location: Date: Charge: Penalty:

    Traffic Convictions 2 Location: Date: Charge: Penalty:

    Traffic Convictions 3 Location: Date: Charge: Penalty:


    EXPERIENCE AND QUALIFICATIONS – DRIVER

    List all driver licenses or permits held in the past 3 years.

    State: License Number: Type: Expiration Date:

    State: License Number: Type: Expiration Date:

    State: License Number: Type: Expiration Date:

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

    B: Has any license, permit or privilege ever bee suspended or revoked?

    IF THE ANSWER IS TO EITHER A OR B IS YES, GIVE DETAILS

    Do you have driving experience?:


    CLASS OF EQUIPMENT


    Tractor and Semi-Trailer:

    Tractor - Two Trailers:

    Tractor Three Trailers:

    Motorcoach - School Bus (More than 8 passengers.)

    Motor-coach - School Bus Other (More than 15 passengers.)

    Other:

    Equipment Type 1: Dates: Appox. No. of Miles (Total):

    Equipment Type 2: Dates: Appox. No. of Miles (Total):

    Equipment Type 3: Dates: Appox. No. of Miles (Total):

    List states operated in for last five years:

    Which safe driving awards do you hold and from whom?


    EXPERIENCE AND QUALIFICATIONS - OTHER


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

    List courses and training other than shown elsewhere in the application:

    List special equipment or technical materials you can work with (other than already shown):


    EDUCATION


    Highest Grade Completed:

    Last School Attended & Location (city & state):


    TO BE READ AND SIGNED BY 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.