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Employment Application

Personal Description

Have you ever worked for this company? IF YES, FROM: TO:
Are you employed?
ARE YOU PREVENTED FROM LAWFUL EMPLOYMENT IN THIS COUNTRY BECAUSE OF IMMIGRATION STATUS?
HAVE YOU EVER BEEN CONVICTED OF A FELONY, MISDEMEANOR, OR CRIMINAL VIOLATION?

Driver's License Information (This info will be verified)

CDL Endorsements:

Education

do you have full knowledge of the federal motor carrier safety regulations?

Driving experience

Truck: None
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Trailer/Tank: None
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Straight Truck: None
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Bus: None
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Other: None
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

accident record last three years (this info will be verified)

Traffic convictions and forfeitures (other than parking) last three years (this info will be verified)

Employment History

Non-CDL driver applicants must provide 3 years employment history. CDL driver applicants must provide 10 years. We are required under §391.23 to investigate your safety performance history of all Federal Motor Carrier Safety Administration regulated employers that you worked for in the preceding 3 years. We are required to investigate your participation in a U.S. DOT mandated drug and alcohol testing program, whether you violated and probations under §382 subpart B, and whether you failed to undertake or complete rehabilitation as required under §382.605 or subpart O §40 of all U.S. DOT regulated employers that you worked for in the preceding 3 years. You must give written consent for these investigations in order to be considered for employment as a driver. You have due process rights regarding the information received from the investigations under §391.23(i).

All information obtained from previous employers will be kept confidential.

did you perform "safety sensitive functions" while employed? did you operate a cdl vehicle?
were you subject to the federal motor carrier safety regulations while employed?
were you required to participate in a u.s. dot mandated drug and alcohol testing program?
did you perform "safety sensitive functions" while employed? did you operate a cdl vehicle?
were you subject to the federal motor carrier safety regulations while employed?
were you required to participate in a u.s. dot mandated drug and alcohol testing program?
did you perform "safety sensitive functions" while employed? did you operate a cdl vehicle?
were you subject to the federal motor carrier safety regulations while employed?
were you required to participate in a u.s. dot mandated drug and alcohol testing program?
did you perform "safety sensitive functions" while employed? did you operate a cdl vehicle?
were you subject to the federal motor carrier safety regulations while employed?
were you required to participate in a u.s. dot mandated drug and alcohol testing program?

Notice to applicant

Applicant - If employer has not explained or given a job description, make sure one is given to you and that you fully understand what is expected of you prior to answering the following two questions.

please explain how, with or without reasonable accommodation, you will be able to perform those functions.

Applicant must read and sign

  • I agree and understand that any misrepresentations or omissions of information or facts given on this form shall be considered an act of falsification.
  • I agree and understand that the carrier or its agents may investigate any and all information given on this form to determine its validity.
  • I understand that all employment history information from previous employers will be used by the carrier only as part of deciding whether to hire me.
  • I understand that under U.S. DOT regulation §391.23(i), I cannot bring an action or proceeding for defamation, invasion of privacy, or interference with a contract against this carrier or any previous employer base on furnishing or using employment history information.
  • I agree to furnish such additional information and complete such examinations as may be required to complete my driver qualification and employment files.
  • If hired, I agree to abide by all the rules and policies of this carrier.

Office use only

Application Received:
Date
Signature of Company Representative
Date of Hire

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