Drivers Application You can also download a PDF version of our drivers employment application to fill out and bring in to any of our locations. Job Code (if known) First Name Middle Initial Last Name List your addresses for the past 3 years. Current Address Address How Long? City State Zip/Postal Code Telephone - - E-Mail Address Previous Address Address How Long? City State Zip/Postal Code Previous Address Address How Long? City State Zip/Postal Code Do you have the legal right to work in the United States? Yes No Date of Birth Can you provide proof of age? Yes No Have you ever worked this company before? Where? Yes No Dates: From To: Rate of Pay Position Reason for leaving Are you now employed? If not, how long since leaving last employment Yes No 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 attached job description)? Yes No If yes, explain if you wish: 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.) * 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. Employer #1 (most recent) Name Address City State Zip Contact Person Phone Number From MO./YR. To MO./YR. / / Position Held Salary/Wage Reason for Leaving Employer #2 Name Address City State Zip Contact Person Phone Number From MO./YR. To MO./YR. / / Position Held Salary/Wage Reason for Leaving Employer #3 Name Address City State Zip Contact Person Phone Number From MO./YR. To MO./YR. / / Position Held Salary/Wage Reason for Leaving Employer #4 Name Address City State Zip Contact Person Phone Number From MO./YR. To MO./YR. / / Position Held Salary/Wage Reason for Leaving Employer #5 Name Address City State Zip Contact Person Phone Number From MO./YR. To MO./YR. / / Position Held Salary/Wage Reason for Leaving ACCIDENT RECORD FOR PAST 3 YEARS OR MORE CHECK HERE IF NONE   Dates Nature of Accident (Head-On, Rear-End, Upset, Etc.) Fatalities Injuries Last Accident Next Previous Next Previous TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) CHECK HERE IF NONE Location Date Charge Penalty EDUCATION Highest Grade Completed First GradeSecond GradeThird GradeFourth Grade Fifth GradeSixth GradeSeventh GradeEighth GradeNinth Grade Tenth GradeEleventh GradeTwelfth GradeOne Year College Two Year CollegeThree Year CollegeFour Year College Last School Attended Name City EXPERIENCE AND QUALIFICATIONS - DRIVER Driver Licenses State License No. Type Expiration Date A. Have you been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Has any license, permit or privilege ever been suspended or revoked? Yes No If the answer to either A or B is yes, give details below: DRIVING EXPERIENCE CHECK HERE IF NONE Class of Equipment Type of Equipment (Van, Tank, Flat, Etc.) Dates From To Approx. No. of Miles (Total) Straight Truck Tractor and Semi-Trailer Tractor - Two Trailers Motorcoach - School Bus Other List 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? EXPERIENCE AND QUALIFICATIONS - OTHER 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): By clicking "Submit Application" below, I certify 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. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, 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 inquires 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.

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