Driver's Application For Employment

Contact Info

 
 

(718) 456-1800

 

All fields marked with (*) are required.

 

General Information

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.

Rights Waiver

TO BE READ AND SIGNED BY APPLICANT

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. (Generall, 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 employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Termination Information
Applicant Details
Last, First, Middle
All SSN Information is Securely Stored via Database Encryption
(Required for Commercial Drivers)
Addresses
List Your Addresses of Residency for the Past 3 Years.
Current Address
(xxx) xxx-xxxx
Yr./Mo.
Previous Addresses
Street, City, State and Zip code
Street, City, State and Zip Code
Street, City, State & Zip Code
Dates:
Employment History

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a 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.)

Employer 1
(xxx) xxx-xxxx
Put Today If Still Employed
Employer 2
(xxx) xxx-xxxx
Put Today If Still Employed
Employer 3
(xxx) xxx-xxxx
Put Today If Still Employed
Employer 4
(xxx) xxx-xxxx
Put Today If Still Employed
Employer 5
(xxx) xxx-xxxx
Put Today If Still Employed
Accident Record
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE. IF NONE, WRITE "NONE"
Last Accident
(Head-on, Rear-end, Upset, Etc)
Next Previous Accident
(Head-on, Rear-end, Upset, Etc)
Next Previous Accident
(Head-on, Rear-end, Upset, Etc)
Traffic Convictions
Incident #1
Incident #2
Incident #3
Experience and Qualifications - Driver
License #1
License #2
License #3
License #4
If Either of the Above Two Answers is Yes, Give Details
Driving Experience
Straight Truck
Tractor and Semi-Trailer
Tractor - Two Trailers
Tractor - Three Trailers
Motorcoach - School Bus (8+ Passengers)
Motorcoach - School Bus (15+ Passengers)
Other
Other XP and Qualification
Education
(Name) (City, State)
To Be Read and Signed By Applicant

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