Application for Employment

Please note: You may type as much in the comment boxes as needed.

Which location are you applying for?

Last Name First Name Middle Name
What position are you applying for?
What is a good time to reach you concerning the application?

List your addresses of residency for the past 3 years

Current Address
Street: City: State:
Zipcode: How long ?    
Phone:        
           
Previous Addresses
Street: City: State:
Zipcode: How long ?    
           
Street: City: State:
Zipcode: How long ?    
           
Street: City: State:
Zipcode: How long ?    

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

Date of Birth: / / Can you provide proof of age?

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

Do you have any friends or relatives that have ever worked for this company before?

Are you currently employed?
If not, how long since last employment?

Who referred you? Rate of pay expected:

Is there any reason you might be unable to perform the functions of the job for which you have applied?

If yes, explain if you wish:


Employment History

All driver applicants to drive in interstate commerce must provide the following information on all exmployers 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.

Please list employers in reverse order starting with the most recent.

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:  

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:  

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:

Employer Name: Dates:
Address: Position:
City: State: Zip: Salary/Wage:
Contact: Reason for Leaving:
Phone:

Accident record for past 3 years or more (most recent first, then in reverse order):
Dates
Nature of Accident
Fatalities
Injuries

Traffic Convictions and Forfeitures for the past 3 years (other than parking violations):

Date
Location
Charge
Penalty

Education

Highest Grade Completed:
Last School Attended:
City:

Experience and Qualifications - Driver

Driver Licenses:

State License # Type Expiration

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

Has any license, permit, or priviledge ever been suspended or revoked?

If yes to either statement, please include details below:

Driving Experience

Class of Equipment Type of Equipment
(Van, Tank, Flat, etc.)
Dates Approx. No.
of Miles
Straight Truck
Tractor & Semi
Tractor - Two Trailer
Motorcoach - Bus
Other

List states operated in for last five years:

Special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

 

* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.