Drivers Application for Employment
       
First name: Last name:
Address: City:
State: Zip:
Phone: Position applied for:
Date of Birth:    
Social Security: Please read disclaimer
Do you have the legal right to work in the United States?
Can you provide legal proof of age:
Have you worked for this company before?
If so, where
Dates worked: From: to
Rate of pay: per
Position:
Reason for leaving:
Are you now employed?
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected? per
Have you ever been bonded?
Name of bonding company
Have you ever been convicted of a felony?
If yes, please explain fully. 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 preform the functions of the job for which you applied (as described in the attached job description)
If yes, expalin if you wish.
Employment History
Employer Name
Address
City
State
ZIP
Contact Person
Phone Number
Date Employed From To
Position Held
Salary/Wage per
Were you subject to the FMCSRs 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?
Employment History 2
Employer Name
Address
City
State
ZIP
Contact Person
Phone Number
Date Employed From To
Position Held
Salary/Wage per
Were you subject to the FMCSRs 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?
Employment History 3
Employer Name
Address
City
State
ZIP
Contact Person
Phone Number
Date Employed From To
Position Held
Salary/Wage per
Were you subject to the FMCSRs 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?
Accident Record for the Past 3 Years (skip if none)
  Dates Nature of Accident Fatalities Injuries Hazardous Material Spill
Last Accident
Next Previous
Next Previous
Traffic Convictions and Forfeitures for the past 3 Years (other than parking violations)
Location Date Charge Penalty
Experience and Qualifications - Driver

Driver

Licenses

 State License No. 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 privilage ever been suspended or revoked?
If the answer is YES, please give details.
Class of Equipment
Experience with:
 Type From To Approx. No.of Miles (total)
Straight Truck
Tractor & Semi Trailor
Tractor - 2 trailors
Tractor - 3 trailors
Motorcoach - School bus
(more than 8 passengers)		  
Motorcoach - School bus
(more than 15 passengers)		  
Other
List any states operated in for the last 5 years:
List any special courses or training that will help you as a driver:
Which safe driving awards do you hold and from whom?
Experience and Qualifications - OTHER
List any trucking, transportation or other experience that may help in your work for this company:
List courses and training other than shown elsewhere in this application:
List special equipment or technical materials you can work with (other than those already shown):
Education
Highest grade completed: High School: College
Last school attended:
City  State 

 

 


By submitting this application, I certify that it was completed by me, and that all entries in it and information in it are true and complete to the best of my knowledge.