Driver's Application For EmploymentApplicant NameCompanyAddressCityStateZip CodeIn compliane with Federal and State equal employment opportunities laws, qualified applicants are considered for allpositions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job relateddisability, or any other protected group status.
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make such investigations and inquireis of my personal, employment, financial or medial history and other relatedmatters as may be necessary in arriving at an employmnet decision. (Generally, inquireis regarding medical history will be made onlyif and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers andother personal 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 indischarge. I understand, also, that I am required to abide by all rules and regulations of the Company.I understand that information I provide regbarding current and/or previous employers may be used, and those employer(s) will becontacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that Ihave the right to:* Review informatioun provided by previous employers;* Have errors in the information corrected by previouse employers and for those previouse employers to re-send the correctedinformatioun to the prospective employer; and* Have a rebuttal statement attached to the alleged erroneous informatioun, if the previous employer(s) and I cannnot agree on theaccuracy of the information.
APPLICANT TO COMPLETE
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3years. 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 withthe most recent. Add another sheet as necessary.)
*Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver),or any size vehicle used to transport hazardous materials in the quantity requiring placarding.^The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstatecommerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,0001 pounds or more, (2) isdesigned or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardousmaterials in a quantity requiring placarding.
ACCIDENT RECORD for past 3 years or more (attach sheet if more space is required). If non, write none.
TRAFFIC CONVICTIONS and forfeitures for the past 3 years (other than parking violations). If none, write none.
EXPERIENCE AND QUALIFICATIONS - DRIVERList all driver licenses or permits held in the past 3 years
DRIVING EXPERIENCE check yes or no Class of Equipment
TO BE READ AND SIGNED BY APPLICANTThis certifies that this application was completed by me, and that all entries on it and information in it are true and complete to thebest of my knowledge.