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.
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:
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?
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)?
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.
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.
For past 3 years or more. If none, write none.
Traffic convictions and forfeituresfor the past 3 years (other than parking violations). If none, write none.
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?
Tractor and Semi-Trailer
Tractor - Two Trailers
Tractor - Three Trailers
Motorcoach - School Bus (More than 8 passengers)
Motorcoach - School Bus (More than 15 passengers)
First Type of Equipment
Second Type of Equipment
Third Type of Equipment
Fourth Type of Equipment
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
Please Select the Highest Grade Completed (only select those that apply)
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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