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, veteran status, non-job related disability, or any other protected group status.
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
I understand that information I provide regarding current and/or previous employers may be used, and those employers(s) will be contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23(d) and (e). I understand that I have the right to:
List your addresses of residency for the past 3 years.
If yes, please explain fully below. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered.
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.
All driver applicants to drive in interstate commerce must provide the following on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.
Applicants to drive 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.
(NOTE: List employers in reverse order starting with the most recent.)
*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 ona highway in interstate commerce to transport passengers or property when the vehilce: (1) weighs o has a GVWR of 10,001 pounds 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 for past 3 years or more if none, write NONE
TRAFFIC CONVICTIONS and forfeitures for the past 3 years (other than parking violations) if none, write NONE
A. Have you ever been denied a licsnse, permit or privilege to operate a motor vehicle? Yes No
B. Has any license, permit or privilege ever been suspended or revoked? Yes No
IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS
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?
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: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4
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.