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If you've not lived at your current address above for at least 5 years, please list your previous adress(es) for the past 5 years.  If you select "Less Than 5 Years" a new address block will appear for you to add a second address.  If you need space for additional addresses, check the "Select if additional address is required" box after you've added a second address.

 

 

Is there any reason you might not be able to perform the functions of the job for which you are applying?  If NO, please follow the instructions and fill out the additional information (Required if you select NO as an answer)

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.)

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?

If you need additional space to add more previous employers, just check the box below to add more employers.

 

ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE (ADDITONAL SPACE FOR REPORTING IS AVAILABLE AT THE END OF THIS APPLICATION)

 


TRAFFIC CONVICTIONS & FORFEITURES

Have You had ANY TRAFFIC CONVICTIONS AND/OR FORFEITURES FOR THE PAST # YEARS (other than parking violations)?  If Yes, check the box below and fill out the required information concerning this/these convictions or forfeitures.

 

EXPERIENCE & QUALIFICATIONS


 

If you are licended in more than one state, or hold more than one license in a state, please include them here by checking the box below.  Additional space will be provided at the end of this application to list any additional licenses you may not have room for here.

DRIVING EXPERIENCE

For Each, please select Yes or No and the Type if available


 

List all states in which you've operated in for the last 5 years.

List all special courses or training you may have received directly related to your requested job position.

List any special equipment of technical materials you are qualified to work with or have had experience working with (other than those already provided in the previous sections).

Please select your highest grade level completed

Your last school attended (if None, type None)

 

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge.

In compliance with Federal and State equal employment opportunity 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.


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. (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 inter- view(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.

 

 

 


If you need more space to add additional items you did not have room for on the application, please check the box below and an area for adding all of your additional items will become available.

PLEASE REVIEW YOUR APPLICATION BEFORE SUBMITTING

Correct any mistakes on your application before submitting.  Applications with missing or incorrect information may be rejected.  You have agreed to allow us to investigate your application and to perform inquiries as necessary to verify the information you have submitted.  We may require further information and if so, will contact you with specifics regarding the nature of the information we may require, including police reports, court records and more.

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