(307)-670-9038

DRIVER'S APPLICATION FOR EMPLOYMENT

Please upload, or fax (307-670-9039) a current (not more than 60 days old) Motor Vehicles Report from your licensing state. This will further the application process.

APPLICANT FORM

NOTE: Fields with * are required.

   
   
If yes to felony, please explain:
Date of Birth: *
Issue Date of CDL: *
:
Street : City:
  State: Zip Code:
  Phone * : How Long [Years/months]:
Previous Address: Street : City:
  State: Zip Code:
   How Long [Years/months]:
Previous Address: Street : City:
  State: Zip Code:
   How Long [Years/months]:
Previous Address: Street : City:
  State: Zip Code:
   How Long [Years/months]:
   
Can you provide proof of age?    
Have you worked for this company before?         Where?
Date: From:   To :    Rate of Pay :   Position :
Reason for leaving:
Are you now employed?         If not, how long since leaving last employment? 
Who referred you?: Rate of pay expected:
Have you ever been bonded?:     Name of bonding company:
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]?        
If yes, please explain:
EMPLOYMENT HISTORY - 10 YEARS OF HISTORY REQUIRED Most Recent employer first

EMPLOYER 1

      
City*: State*:
  Zip*:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        

EMPLOYER 2

      
City: State:
  Zip:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        

EMPLOYER 3

      
City: State:
  Zip:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        

EMPLOYER 4

      
City: State:
  Zip:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        

EMPLOYER 5

      
City: State:
  Zip:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        

EMPLOYER 6

      
City: State:
  Zip:  
Contact Person: PHONE NUMBER:
Date:
From: To:
Salary: Position:
 
Reason for leaving:
Were you Subject to the FMCSRS while Employed?        
Was your job designated as a safety-sensitive function in any DOT-REGULATED mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? :        
Accident record for past 3 years or more. IF NONE, ENTER NONE
Dates Nature of Accident Fatalities Injuries Hazardous material spill
Last Accident:
Next Previous:
Next Previous:
Traffic Convictions and forfeitures for the past 3 years (Other than parking, IF NONE, ENTER NONE)
Location Date Charge Penalty
Experience and Qualifications - Driver

Driver Licenses or permits held in the past 3 years

State Licenses No Class Endorsement (s) Expiration Date
   
   

Has a license or permit ever been suspended to operate a motor vehicle?

If the answer to either A or B is Yes, Give Details:

Driving Experience Check Yes or NO
Class OF Equipment Equipment Type Dates Approx No. Of Miles (Total)
From To
Straight Truck :    
Tractor and Semi- Tractor    
Tractor – Two Trailers    
Tractor – Three Trailers    

Motor coach – School Bus

     

Motor coach – School Bus

     
Other  
List states operated in for the last five years:
List 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 training other than shown elsewhere in this application :
List special equipment or technical materials you can work with (other than those already shown)
Education:

Highest Grade Completed:
                       

High School:
           

College:
           

Last School Attended : Name     City


Attachments:
Attach Resume Now :           
Attach Motor Vehicles Report Now :           
Certification and Release:

I certify that I have read and understand the applicant note of this form and the answers given by me to the foregoing questions and the statements made by me are complete and true to my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, people, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

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