Employment Application

23 years or older
2 years commercial driving experience
CDL-A Required
Pass DOT Physical
Pass pre-employment drug screen
Flatbed experience preferred not required
401k with employer match offered after 90 days
Medical, Dental, Vision, Life and Short Term Disability Insurances offered after 90 days

Name *

First

Last

Social Security Number *

Format: 000-00-0000

Date of Application *//

TO BE READ AND SIGNED BY APPLICANT

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 In have the rights 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
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

Signature

Date of Application *//

Position Applied For *

Please list your addresses of residency for the past 3 years

Address 1 *

Address Line 1

Address Line 2

City

State

Zip Code

Address 2

Address Line 1

Address Line 2

City

State

Zip Code

Address 3

Address Line 1

Address Line 2

City

State

Zip Code

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? *

Who referred you? *

Rate of pay expected *

Format: $$/hour

Have you ever been bonded?

Answer only if a job requirement

Can you perform, with or without reasonable accommodation, the essential functions of the job [as described in the attached job description]? *

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 of information on those employers for whom the applicant operated such vehicle. NOTE: List employers in reverse order starting with the most recent.

Company Name *

From *//

To *//

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Position held *

Reason for leaving *

Contact person *

First

Last

Phone number *

Were you subject to 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? *

* Includes vehicles having a 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 a 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) weights or has GVWR of 10,001 lbs. or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record

Last Accident

Date//

Nature of Accident

Fatalities

Hazardous Material Spill

Next Previous

Date//

Nature of Accident

Fatalities

Hazardous Material Spill

Traffic Convictions

Date//

Location

Charge

Penalty

Date

Location

Charge

Penalty

Driver's licenses or permits held in the last 3 years

State *

License Number *

Class *

Endorsement(s) *

Expiration Date *

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

Has any license, permit, or privilege ever been suspended or revoked? *

Driving Experience

From *//

To *//

Approximate Number of Miles *

List states operated in for the last five years: *

Show special courses or training that will help you as a driver: *

Which safe driving awards do you hold asnd from whom?

Experience and Qualifications - Other

Show 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)

Highest Grade Completed *

Last School Attended *

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.

Signature *

Date *//

Phone