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  Monday, June 17, 2019

D R I V E R   A P P L I C A T I O N   F O R M S
(Answer all questions)

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.
1.) APPLICATION INFORMATION
Date of application:
Position(s) Applied for:
Have you worked for this company before?
Where?
Dates: From  Select your From Date
Dates: To  Select your To Date
Rate of Pay $
Position:
Reason for Leaving:
Are you now employed?
how long since leaving last employment?
Who referred you?
Rate of pay expected:
2.) PERSONAL INFORMATION:
Name:
Social Security #
Address
City
Province/State
Postal Code / Zip
Phone
Address For Past 3 Years:
No Old Address

Date of Birth:
 Select your Birthday
Can you provide proof of age?
Are you a U.S. Citizen?
In case of emergency notify:
 
 
3.) PHYSICAL HISTORY:
NOTICE: A DRUG TEST IS A PART OF OUR PRE-EMPLOYMENT PHYSICAL
List any handicap that prevents you from doing certain kinds of work
Are you physically capable of heavy manual work?
Ever injured on the job?
Give nature & degree of such injuries:
How much time lost from work in past three years for illness?
Would you be willing to take a physical examination?
4.) EMPLOYMENT HISTORY:
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle * in intrastate or interstate commerce shall also provide an additional 10 years information on those employers for whom the applicant operated such vehicle.
No Employement History


  • 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.
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE
No Accident History

TRAFFIC CONVISTIONS AND FORFEITURES FOR THE PAST 3 YEARS
(OTHER THAN PARKING VIOLATIONS)
No Forfeitures
5.) EDUCATION:
CIRCLE HIGHEST GRADE COMPLETED

HIGH SCHOOL

COLLEGE:

LAST SCHOOL ATTENDED:

6.) EXPERIENCE & QUALIFICATIONS - DRIVER:
No Experience & Qualifications
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license, permit or privilege ever been suspended or revoked?

IF THE ANSWER TO EITHER A OR B IS YES, ATTACH A STATEMENT GIVING DETAILS

DRIVING EXPERIENCE
Class of Equipment - Straight Truck
Type of Equipment (Van, Tank, Flat, ETC) Approx. No. Of Ml/KM (Total)
From Select From Date To Select To Date
Class of Equipment - Tractor & Semi-Trailer
Type of Equipment (Van, Tank, Flat, ETC) Approx. No. Of Ml/KM (Total)
From Select From Date To Select To Date
Class of Equipment - Tractor - Two Trailers
Type of Equipment (Van, Tank, Flat, ETC) Approx. No. Of Ml/KM (Total)
From Select From Date To Select To Date
Class of Equipment - Other
Type of Equipment (Van, Tank, Flat, ETC) Approx. No. Of Ml/KM (Total)
From Select From Date To Select To Date
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 and from whom?

EXPERIENCE & 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)


CREDIT APPLICATION
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