Driver's Application For Employment

Contact Info

 
 

(718) 456-1800

 

All fields marked with (*) are required.

 

General Information
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
Dates:

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 hereby authorize you to release the following information to Galasso Trucking for purposes of investigation as required by Sections 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.

In accordance with the provisions of Sections 604 and 607 of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), I hereby certify the following:

  1. The consumer (applicant) has authorized in writing the procurement of this report;
  2. The consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for employment purposes;
  3. The information requested below will be used for a "permissible purpose" (i.e., information for employment purposes) and will be used for no other purpose;
  4. The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation; and
  5. Before taking adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.

I also hereby certify that this report request and the above applicant's release notice meet the definition of "permissible uses" of state motor vehicle records under the provisions of the Driver's Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Section 300002(a)).

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
Accident Record/Traffic Convictions
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
If Either of the Above Two Answers is Yes, Give Details
Driving Experience
Straight Truck
Tractor and Semi-Trailer
Other
Other XP and Qualification
Education
(Name) (City, State)
To Be Read and Signed By Applicant

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