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?*
Yes No
Are you a citizen of the United States?*
Yes No
If no, do you possess a valid work permit?*
Yes No
In case of emergency, notify:
Name
Address
Phone
Employment Information
Have you worked for this company before?
Yes No
Date employed from
Date employed to
Rate of Pay
Position
Reason for Leaving
Are you employed now?*
Yes No
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)?*
Yes No
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?*
Yes No
Name of bonding company
Have you ever been refused bond?*
Yes No
If yes, why?
Have you ever been convicted of a felony?*
(Conviction of a crime will not automatically result in the declination of employment)
Yes No
List Convictions
Have you ever worked for this company under another name?*
Yes No
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?
Yes No
Has any license, permit, or privilege been suspended or revoked?
Yes No
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.
