Employment Application

Drivers Application for Employment

Your Name*

Your Email*

Social Security Number*

Position(s) Applied for*

List your addresses of residency for the past 3 years

Current Address

Street*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

How Long*

Address for the Past 3 years:

Address 1

Street

City

State

Zip Code

Home Phone

How Long

Address 2

Street

City

State

Zip Code

Home Phone

How Long

Address 3

Street

City

State

Zip Code

Home Phone

How Long

General Information

Date of Birth*

Can you provide proof of age?*
YesNo

Are you a citizen of the United States?*
YesNo

If no, do you possess a valid work permit?*
YesNo

In case of emergency, notify:

Name

Address

Phone

Employment Information

Have you worked for this company before?
YesNo

Date employed from

Date employed to

Rate of Pay

Position

Reason for Leaving

Are you employed now?*
YesNo

If not, how long since last employment?

Who referred you?

Rate of pay expected?

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*
YesNo

If yes, explain if you wish

Names of relative in our employ

Education

What is the Highest Grade you completed?*

Last School Attended Name*

Last School Attended City*

General

Have you ever been bonded?*
YesNo

Name of bonding company

Have you ever been refused bond?*
YesNo

If yes, why?

Have you ever been convicted of a felony?*
(Conviction of a crime will not automatically result in the declination of employment)
YesNo

List Convictions

Have you ever worked for this company under another name?*
YesNo

If yes, what name?

Date of DOT physical examination

Experience and Qualification - Driver
(List all Licenses held for proceeding 3 years)

Drivers License 1

State*

License Number*

Type*

Expiration Date*

Drivers License 2

State

License Number

Type

Expiration Date

Drivers License 3

State

License Number

Type

Expiration Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
YesNo

Has any license, permit, or privilege been suspended or revoked?
YesNo

If the answer to either of the above questions is yes, attach a statement giving details

Accident Record For Past 3 Years Or More

Accident 1

Date(s)

Location

Nature of Accident

Fatalities

Injuries

Accident 2

Date(s)

Location

Nature of Accident

Fatalities

Injuries

Accident 3

Date(s)

Location

Nature of Accident

Fatalities

Injuries

Traffic Convictions And Forfeiture For The Past 3 Years (Other Than Parking Violations) If None Write None

Traffic Conviction 1

Location

Date

Charge

Penalty

Traffic Conviction 2

Location

Date

Charge

Penalty

Traffic Conviction 3

Location

Date

Charge

Penalty

Employment History

Latest Employer

Name*

Address*

City*

State*

Zip Code*

Contact Person*

Phone*

Start Date*

End Date*

Position Held*

Salary Wage*

Reason For Leaving*

Employer 2

Name

Address

City

State

Zip Code

Contact Person

Phone

Start Date

End Date

Position Held

Salary Wage

Reason For Leaving

Employer 3

Name

Address

City

State

Zip Code

Contact Person

Phone

Start Date

End Date

Position Held

Salary Wage

Reason For Leaving

Employer 4

Name

Address

City

State

Zip Code

Contact Person

Phone

Start Date

End Date

Position Held

Salary Wage

Reason For Leaving

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.

Driving Experience (if none, write none)
Must have at least 2 years driving experience

Straight Truck

Type of Equipment

Start Date

End Date

Approx Number of miles

Tractor & Semi Truck

Type of Equipment*

Start Date*

End Date*

Approx Number of miles*

Tractor & Two Truck

Type of Equipment

Start Date

End Date

Approx Number of miles

Other

Type of Equipment

Start Date

End Date

Approx Number of miles

Experience and Qualifications - Other

List of states operated in for 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)

To be read by applicant

It is agreed and understood that any misrepresentation of information given above shall be considered an act of dishonesty and sufficient cause for dismissal.

It is agreed and understood that the employer or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

The applicant agrees to furnish such additional information and complete such examination as may be required to complete his employment file.

It is agreed and understood that if hired, the employee may be on a probationary period which time he may be discharged without recourse.

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.


By checking box, I agree with the terms stated above for the applications.