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Job Application | Altogas

Application for Driver Position


In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without reqard 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 that 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.

Unless otherwise indicated, please fill in all fields.



Applicant to Complete


Name

Current Address

Previous Addresses

Personal Information

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

Can you provide proof of age?



Have you worked for this company before?

Dates Employed





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)?

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers curing the preceding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drve a commercial motor vehicle* in intrasate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operate such vehicle.

NOTE: List employers in reverse order starting with the most recent.



Position 1





Dates Employed



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?



Position 2





Dates Employed



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?



Position 3





Dates Employed



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?



Position 4





Dates Employed



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?



Position 5





Dates Employed



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?



Position 6





Dates Employed



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?



*Includes vehicles having a 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 a quantity requiring placarding.

†The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Driving Information


Accident Record

For past 3 years or more. If none, write none.


Traffic Convictions

Traffic convictions and forfeituresfor the past 3 years (other than parking violations). If none, write none.


Experience and Qualifications - Driver

Driver's licenses or permits held in the past 3 years.



A.) Have you ever been denied a license or privilage to operate a motor vehicle?

B.) Has any license, permit, or privilige ever been suspended or revoked?


Driving Experience

Class of Equipment

Straight Truck

Tractor and Semi-Trailer

Tractor - Two Trailers

Tractor - Three Trailers

Motorcoach - School Bus (More than 8 passengers)

Motorcoach - School Bus (More than 15 passengers)

Other

Select Type of Equipment

First Type of Equipment

Second Type of Equipment

Third Type of Equipment

Fourth Type of Equipment

Dates

Approximate Number of Miles

Straight Truck Miles

Tractor and Semi-Trailer Miles

Tractor - Two Trailers Miles

Tractor - Three Trailers Miles

More Than 8 Passengers Miles

More Than 15 Passengers Miles

Other Equipment Miles





Experience and Qualifications - Other



Education

Please Select the Highest Grade Completed (only select those that apply)

Last School Attended

To Be Read and Signed By Applicant


This certifies that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.

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