Driver application

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Driver application

Position

Owner operator

Applicants name

Company name

State

Driver for the company

Date of application

Address

Zip code

City

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 inquiries 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 of employment has been extended.) I hereby release employers, schools, health care providers and other persons 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 in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. 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.

Signature _________________________

Date _________________________

PROCESS RECORD

Applicants hired

Date employed

Departament

Rejected

Point employed

Classification

(If rejected, summary report of reasons should be placed in file)

Signature of hiring officer ____________________

TERMINATION OF EMPLOYMENT

Date terminated

Dismissed

Termination report placed in file

Department released from

Voluntary quit

Supervisor

Other

Position(s) applied for

First name

Social security nr.

Emergency contact name

Cell phone

Second name

E-mail address

Phone nr.

Middle name

Relationship

List your addresses of residency for the past 3 years:

Current address

Street

Zip Code

City

How long? (yr./mo.)

State

Previous address #1

Street

Zip Code

City

How long? (yr./mo.)

State

Previous address #2

Street

Zip Code

City

How long? (yr./mo.)

State

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

Yes

Have you worked for this company before?

Yes

Date of birth (required for commercial drivers)

Where?

Dates from (yr. / mo.):

To (yr. / mo.):

position

Rate of pay

Reason for leaving

Are you now employed?

Yes

Who referred you?

If not, how long since leaving last employment?

Rate of pay expected

Have you ever been convicted of a felony?

Yes

If yes, please explain fully in a separate e-mail. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

Yes

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

DRIVER EXPERIENCE (check Yes or No)

List states operated in for the last five years:

Show special courses or training (that will help you as a driver):

EXPERIENCE AND QUALIFICATIONS – OTHER

Show any trucking, transportation or other experience that may help in your work for this company:

List courses and trainig other than shown elsewhere in this application:

List special equipment or technical materials you can work with (others than those already shown):

EDUCATION

Last school attended:

Name:

TO BE READ AND SIGNED BY APPLICANT

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.

Signature _________________________

Date _________________________