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In compliance with Federal an State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national orgin, age, marital status, or non-job related disability.

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List your addresses of residency for the past 3 years.

Are you a U.S. Citizen or otherwise lawfully authorized to work in this country?
Have you ever been convicted of a felony?

(A conviction record will not necessarily ban you from employment. Such factors as age and time of the offense, seriousness and nature of the violation will be taken into account.)

Have you worked for this company before?
Are you now employed?
Have you ever failed or refused a pre-employment drug/alcohol test given by a company where you never accepted employment?

Employment History

All driver applicants must provide the following information on all employers in the last 10 years. 

The information provided concerning previous employers may be used to investigate the applicant's safety performance history.

(Note: List employers starting with most recent.)

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Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?
Was the job a safety-sensitive position that was sbject to DOT drug and alcohol testing requirements?

Accident record for the past 4 years

Date               Type of Accident               Location               Type of Vehicle               Fatalities               Injuries

Traffic convictions and forfeitures for the past 4 years

Date               Violation               Location               Type of Vehicle               Penalty/Fine               

Experience and Qualifications--Driver

Drivers Licenses:               State/Licensing Authority               License No.                Type               Expiration Date               

Have you held a CDL in any state/licensing authority other than listed above in the last 3 years?
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privelage ever been suspended or revoked?
Is there any reason you might be unable to perform the functions of the job (truck driver) for which you applied? I.E: but not limited to, lifting, loading, unloading, minor maintenance, tarping and securing of loads, fueling, and driving?

Driving Experience

Class of Equipment               Type of Equipment               Dates: From -  To                Approx. No. of Miles                                                                            (Van, Tank, Flat, Etc)

                    

Education

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Check all that apply

Name              Phone No.              Relationship                                  

                    

Name              Phone No.              Relationship                                  

                    

To be read and signed by applicant

Thanks for submitting your application! We will be in touch soon!

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

I hereby authorize my current and previous employers, references, and any other individuals contacted by this company to release any past or present information requested, and I release all providers from all liability in responding to  inquiries and releasing information in connection with my application.

I understand that any false, misleading, or incomplete answers or statements shall be considered sufficient cause for denial or termination of employment and/or authorization to drive.