Truck Driver Application

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, color, gender, national origin, age, marital status, or non-job related disability. Please complete this application thoroughly.

1. Personal Information

First Name *

Middle Name

Last Name *

How long did you live at this address? * Years

Social Security No. * ###-##-####

Date of Birth * your date of birth

Email * a valid email

Cell Phone * (000) 000-0000

Home Phone (000) 000-0000

Current Address * Current Address

Country

2. Please list your previous addresses for the last three (3) years

Street *

City *

State / Province *

Zip/Postal Code *

How long did you live at this address? *

1-5 years 5-10 years More than 10 years

3. Have you ever been employed with us before? If YES, give dates and positions *

pick one!

Yes No

4. Type of employment desired *

pick one!

5. Please list all unexpired licenses and/or permits

State *

Licence/Permit Number *

Expiration Date *

6. Please list the nature and extent of your experience operating different types of motor vehicles (e.g. buses, trucks & trailers)

6a. Type *

6b. Experience in Years *

6c. Miles Driven

7. I certify that I have had no accidents in the last three years *

YES (agree) NO (not agree) Others

8. I certify that NO convictions or bond forfeitures have occurred *

YES (agree) NO (not agree) Others

9. I certify that no such denial, revocation or suspension has occurred *

YES (agree) NO (not agree) Others

10. Employer Name

Please provide information regarding prior employers during the last three (3) years. If you are applying to operate a Commercial Motor Vehicle (GVWR of 26,001 lbs. or more, ability to transport 16 or more people, or any vehicle requiring placarding for hazardous materials), please include complete information regarding prior employers for the last 10 years for whom you operated such vehicles. Please start with your most recent prior employer.

Employer

Employer Name *

Employer Address *

Employer Phone Number

Date From First Day

Date Last Day

Can we contact your employer? *

YES NO

Position

Reason for Leaving *

Salary

11. Was your position “safety-sensitive” requiring Part 40 drug and alcohol testing? *

YES NO

12. Have you ever plead "guilty or " no contest" to, or been convicted of a crime? *

YES NO

APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. All employment and compensation with the Company is “at will” which means that your employment can be terminated with or without cause, at any time, at the discretion of either the Company or yourself, except as otherwise provided by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer has stated the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT I certify that I have read, fully understand and accept all the terms of the this Applicant Statement.

Please type your name below to certify that this application was completed by you, and that all entries on it and information in it are true and complete to the best of your knowledge. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMEN

Signature

I agree to the terms and conditions

Date & Time *

of application

1. Personal Information

2. Please list your previous addresses for the last three (3) years

3. Have you ever been employed with us before? If YES, give dates and positions *

4. Type of employment desired *

5. Please list all unexpired licenses and/or permits

6. Please list the nature and extent of your experience operating different types of motor vehicles (e.g. buses, trucks & trailers)

7. I certify that I have had no accidents in the last three years *

7a. If you clicked NO (not agree). Please list all motor vehicle accidents in which you were involved during the last three (3) years

8. I certify that NO convictions or bond forfeitures have occurred *

10. Employer Name

Employer

11. Was your position “safety-sensitive” requiring Part 40 drug and alcohol testing? *

12. Have you ever plead "guilty or " no contest" to, or been convicted of a crime? *

APPLICANT STATEMENT

Signature

Date & Time *