Trucking Application

Please complete the form to apply for a position with us.

First Name

Last Name

Social Security Number

Address

City

State

Zip Code

Phone

Date of Birth

Available Start Date

Resume

Upload File

If yes when?

Rate of Pay at time of employment?

Position

Reason for leaving

If not, how long since leaving last employment?

If yes, Name of bonding company

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 interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant such vehicle.
(Note: List employers in reverse order starting with the most recent.)

Employer Name

Employed To

Salary/Wage

Address

Employed From

Position

Phone

Employer Name

Employed From

Employed To

Position

Salary/Wage

Phone

Address

Employer Name

Employed From

Employed To

Position

Salary/Wage

Phone

Address

Accident records for past 3 years or more

Last Accidnet

Nature of Accident

Fatalities

Injuries

Next Previous

Nature of Accident

Fatalities

Injuries

Traffic Convictions & Forfeitures for the past 3 years (other than parking Violations

Location

Date

Charge

Location

Penalty

Date

Charge

Penalty

Experience and Qualifications

List all driver licenses or permits held in the past 3 years

State

License Number

Type

State

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.

To be read and signed by applicant
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 to employment has been extended)

I hereby release employers, schools, health care providers and 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. I understand and agree that, if hired, my employment is for no defined period and may, regardless of the date of payment of my wages and salary, be terminated for any reason at any time without any prior notice. I Further understand that all employees are subject to a 90 day probation period.

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.

Your Signature

In compliance with federal and state equal opportunity laws, qualified applicants are considered for all positions without regard to race, color. Religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.

Trucking Application

Accident records for past 3 years or more

Traffic Convictions & Forfeitures for the past 3 years (other than parking Violations

Experience and Qualifications

List all driver licenses or permits held in the past 3 years

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.

In compliance with federal and state equal opportunity laws, qualified applicants are considered for all positions without regard to race, color. Religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.