Employment Application

    Applicant Information

    Are you a citizen of the United States?

    If no, are you authorized to work in the U.S.?

    Have you ever worked for this company?

    Have you ever been convicted of a felony?

    Education

    Did you graduate?

    Did you graduate?

    Did you graduate?

    *The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designated or used to transport nine or more passengers, or (3) is any size, used to transport hazardous materials in a quantity requiring placarding.

    Previous Employment

    Give a COMPLETE RECORD of all employment for the past TEN (10) YEARS, including any periods of unemployment or self-employment. Use as many pages as necessary. ALL fields MUST be filled in completely.

    Were you subject to the FMCSRs* while employed here?

    Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

    Were you subject to the FMCSRs* while employed here?

    Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

    Were you subject to the FMCSRs* while employed here?

    Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

    Were you subject to the FMCSRs* while employed here?

    Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

    References

    Please list three professional references.

    Driving Experience

    Class of Equipment

    Straight Truck

    Tractor and Semi-trailer

    Tractor-two trailers

    Motor Coach – School Bus

    Other

    Accident Record for the past 3 years, write “NONE” if applicable (attach sheet if additional space is needed) (Please include CMV and Non-CMV accidents)

    Traffic Convictions for the past 3 years, write “NONE” if applicable (attach sheet if additional space is needed)(Please include CMV and Non-CMV convictions)

    Driver’s License (list each driver’s license held in the past three years)

    A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

    B. Has any license, permit or privilege been suspended or revoked?

    C. 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)?

    D. Have you ever been convicted of a felony?

    Military Service

    Disclaimer and Signature

    It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

    It is agreed and understood that the motor carrier 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.

    It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character general reputation, personal characteristics and mode of living.
    I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

    It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant.

    It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified 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.

    Applicant Signature

    Date