Drivers Application for Employment

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.

Applicants Full Name *

Date of Application *

Position(s) Applied for *

TO BE READ AND SIGNED BY APPLICANT

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 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.

Applicant's Signature *

clear

Current Address

Street *

City *

State *

Zip Code *

How Long? *

Have you lived at your current address for 3 or more years? *

Yes

No

If previous answer was Yes, please skip Previous Address Section.

Previous Addresses

Previous Address 1

Street

City

State

Zip Code

How Long?

Previous Address 2

Street

City

State

Zip Code

How Long?

Previous Address 3

Street

City

State

Zip Code

How Long?

United States Employment Information

Do you have the legal right to work in the United States? *

Yes

No

Date of Birth (Required for Commercial Drivers) *

Can you provide proof of age? *

Yes

No

Have you worked for this company before? *

Yes

No

Where?

Position

Dates: From

Dates: To

Rate of Pay

Reason for Leaving

Are you currently employed? *

Yes

No

If not, how long since leaving last employment?

Who referred you? *

Rate of pay expected *

Have you ever been bonded?

Name of bonding company

Can you perform, with or without reasonable accommodation, the essential functions of the job as described in job description? *