Careers

Personal

Full Name *

Home Phone *

Work Phone *

Cell Phone *

E-mail Address *

Current Address

Street Address *

Street Address Line 2

City *

State *

Postal / Zip Code *

Country *

Since *

Prior Address

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Country

From

To

Education

High School

School *

City *

State *

Diploma *

Yes No

Undergrad School

School

City

State

Diploma

Yes No

Deg/Cert/Dip

Area of Study

Other School

School

City

State

Diploma

Deg/Cert/Dip

Area of Study

Military Experience

Have you ever served in the U.S. Armed Forces? *

Yes No

If yes, which branch of service?

If yes, please describe any military training received relevant to the position for which you are applying.

Are you currently serving in the Military Reserves? *

Yes No

Are you currently serving in the National Guard? *

Yes No

Employment

Employment Information

Position Applied For *

Date You Can Start? *

Desired Salary ($) *

Do You Prefer *

Can you work

Weekends Evenings

Are you available for shift work? *

Yes No

Not Available

Driver Experience & Qualifications

The Federal Motor Carrier Safety Regulations (49CFR391.21 (b) (2) requires that driver applicants state their date of birth and Social Security Number.

Birth Date *

Physical History

The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical test before they are hired to drive a motor vehicle.

Social Security Number *

Date of last Department of Transportation prescribed examination *

Can you provide a copy of this examination? *

Yes No

Alcohol & Controlled Substance Statement

The federal Motor Carrier Safety Regulations 49CFR40.20(j) requires all persons applying for a driving position requiring a commercial drivers license to answer the following questions.

1.) Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work? *

Yes No

2.) Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work? *

Yes No

3.) If you answered yes to either 1 or 2 above, can you provide/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes No

Drivers License Information

Driver's Licenses held in the past three (3) years must be listed.

Current Drivers License

State *

License Number *

Type *

Expiration Date *

Additional Drivers License #1

State

License Number

Type

Expiration Date

Additional Drivers License #2

State

License Number

Type

Expiration Date

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

Yes No

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

Yes No

3.) Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? *

Yes No

Driving Experience

Class of Equipment

Start Date

End Date

Approximate Total Miles

Additional Driving Experience

Class of Equipment

Start Date

End Date

Approximate Total Miles

Accident History

Date of Accident

Nature of Accident

Number of Fatalities

Number of Injuries

Number of Vehicles Towed

Citation Issued?

Yes No

Additional Accident History

Date of Accident

Nature of Accident

Number of Fatalities

Number of Injuries

Number of Vehicles Towed

Citation Issued?

Yes No

Motor Vehicle Driving Record (MVR)

Traffic Convictions and Forfeitures for the past three (3) years other than parking violations must be listed.

Date of Conviction

Charge

Penalty

Additional Motor Vehicle Driving Record (MVR)

Traffic Convictions and Forfeitures for the past three (3) years other than parking violations must be listed.

Date of Conviction

Charge

Penalty

1) Are you at least 18 years of age and legally eligible to work for our company in the United States? *

Yes No

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes No

2) Have you worked for this business before? *

Yes No

If yes, Please provide dates & locations

3) Are you on layoff and subject to recall? *

Yes No

4) Have you ever been discharged or asked to resign from a job? *

Yes No

If yes, please explain

5) Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation? *

Yes No

If yes, please explain

6) Do any of your friends or relatives, other than spouse, work here? *

Yes No

If yes, state name and relationship...

Employers

Are you currently employed? *

Yes No

May we contact your present employer? *

Yes No

Most Recent Employer

Employer *

City *

State *

Zip Code *

Phone Number

Position Held

Start Date

End Date

Pay Upon Leaving ($)

Supervisor

Duties

Reason for Leaving

Prior Employer

Employer

City

State

Zip Code

Phone Number

Position Held

Start Date

End Date

Pay Upon Leaving ($)

Supervisor

Duties

Reason for Leaving

Job-related Skills

1) Have you been convicted of or pled guilty to any traffic-related offense within the past five years? *

Yes No

If yes, please explain

2) Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law? *

Yes No

If yes, please explain

3) Please list all states from which you hold or held a driver's license *

Skills

Professional Designations

References

Reference #1

Full Name

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Country

Phone Number

Relationship

Years Acquainted

Reference #2

Full Name

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Country

Phone Number

Relationship

Years Acquainted

Reference #3

Full Name

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Country

Phone Number

Relationship

Years Acquainted

Please upload your resume.

Resume

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Applicant Certification Agreement

1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in. 2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment. 3. If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary. 4. Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ. 5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully. 6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.

Signature

Type Full Name in Signature Box Below *

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