APPLICATION FOR EMPLOYMENT

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Personal Information

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Previous three years residency

License Information

Driving Experience

Straight Track
Tractor and semi-trailer
Tractor - two trailers
Other
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Accident record for past 3 years or more

Traffic convictions and forfeitures for the past 3 years

Other than parking violations
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Employment Record

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers dur ing the previous three years. You must give thesame information for all employers you have driven a commercial motor vehicle for t he seven years prior to the initial three years (total of ten years employment record).
*Must list the complete mailing address: street number and name, city, state and zip code.
Last employer
second Last employer
Third Last employer
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To be read and signed by applicant

I authorize you to make sure investigations and inquiries to 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 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 current/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;
  • • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on th e accuracy of the information.
*This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.
Thank you!
Your application has been received!
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