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Driver Application

You can fill out and submit the form below or if you would prefer click here to print out an application.

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin or handicap. We are an equal opportunity employer.
 
General Information
Last Name: * First Name: * Middle: * Date: *
Address: *  Home #:
E-Mail:   Cell #:
Are you legally entitled to work in the U.S.? Yes No Part Time Day
Position or Type of Employment Desired?: * Full Time Swing
Salary/Wage Desired:: * Graveyard    
Have you worked for us before? Yes No
Willing to Travel?: Yes No
If yes, when?:  Date available: *
How did you learn of our organization?:
                     

Education
Type of School

Name and location of school Course of Study No. of years completed Did you graduate? Degree or Diploma
College
High School
Trade School
Military
Other
                     
Special Skills (List all pertinent skills and equipment that you can operate)
                     
Are you able to perform the essential functions of the job you are applying for? Yes No  
Are you capable of climbing a ladder?  Yes No   If not, why:
Are you capable of lifting 85 lbs? Yes No   If not, why:
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No  
Has any license, permit, or privilege ever been suspended or revoked?  Yes No  
If yes to either of the obove questions, please describe in full:
Have you been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses, which have
not been annulled, expunged or sealed by a court?
Yes   No      
If yes to the obove question, please describe in full:
                     
Work Experience (most recent first, include voluntary work, and military experience)
Employer 1: Telephone # From (Month/Year)

Address:
Job Title: To (Month/Year)
Specific Duties:
    Hours Per Week
   
    Rate/Salary
   
    Supervisor
   
Reason for leaving: May we contact this employer? Yes No
Were you subject to FMCSR's? Yes No Were you in a safety sensitive function in any DOT regulated
mode subject to alcohol and controlled substances testing requirements as required by 49CFR part 40? Yes No
                     
Employer 2: Telephone # From (Month/Year)
Address:
Job Title: To (Month/Year)
Specific Duties:
    Hours Per Week
   
    Rate/Salary
   
    Supervisor
   
Reason for leaving: May we contact this employer? Yes No
Were you subject to FMCSR's? Yes No Were you in a safety sensitive function in any DOT regulated
mode subject to alcohol and controlled substances testing requirements as required by 49CFR part 40? Yes No
                     
Employer 3: Telephone # From (Month/Year)
Address:
Job Title: To (Month/Year)
Specific Duties:
    Hours Per Week
   
    Rate/Salary
   
    Supervisor
   
Reason for leaving: May we contact this employer? Yes No
Were you subject to FMCSR's? Yes No Were you in a safety sensitive function in any DOT regulated
mode subject to alcohol and controlled substances testing requirements as required by 49CFR part 40? Yes No
     
License Information Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, which is listed below.
State License No. Type Expiration Date
                     
Class of
equipment
Type of equipment
Tank, Flat, Dump, Etc.
Dates (Month/Year)
From To
Approximate number of miles

Straight Truck

Tractor & Semi Trailer
Tractor/Trailer off road
Tractor - two trailers
Other
       
Accidents, traffic convictions and forfeitures for the past 3 years (do not include parking violations)
Date
(Month/Year)
Nature of Accident/violation
(Head on, Rear end, Speeding, Etc)
State No. of fatalities No. of injuries Chemical Spills

 
DOT regulations prohibit our utilizing you to perform a "safety-sensitive function" (driving a commercial motor vehicle) if you had a positive or invalid 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.
 
By clicking Submit I certify the information contained in this application is true, correct, and complete. I understand that if employed, false statements reported on this application may be considereed sufficient cause for dismissal.

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