Before You Begin / Step 1 / Step 2 / Step 3 / Step 4 / Step 5 / Step 6 / Step 7
This transportation company is an equal opportunity employer with all Federal and State equal employment opportunity laws. Consideration of qualified applicants for any position is made without regard to the applicant’s sex, race, color, national origin, marital status, age, religion or non-job related disability.
Each Step must be completed before you can proceed to the next Step and every field marked as *Required must be answered in order for the application to be considered.
In order to complete this Application for Employment you will need to have the following information. It is recommended that you have this information available before you proceed because this application can NOT be saved once you begin.
Personal Information
Employment History
Driving Qualifications and Experience
Education
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Position you are applying for*
Name*
The U.S. Department of Transportation requires that driver applicants state their date of birth 391.21(b)(2). Date Of Birth*
Phone Number*
Email Address*
Address*
City*
State* —Please choose an option—AlabamaAlaskaArizonaArkansasAmerican SamoaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasTrust TerritoriesUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip*
Previous Address (Go Back 3 years)
City
State —Please choose an option—AlabamaAlaskaArizonaArkansasAmerican SamoaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasTrust TerritoriesUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip
Can you legally be employed in the United States?* YesNo
Do you have any proof of age? (Required for commercial drivers) * YesNo
Have you ever been employed by this company before? * YesNo
If so, When?
What was your rate of pay?
Position Held?
Reason for leaving:
May we contact your employer? YesNo
If not, how long since you were last employed?
What pay rate are you expecting?
How did you hear about this company?
All drivers are required to load and unload cargo weighing up to 40 lbs. per item and pass a DOT physical. Are you able to lift 40 lbs.?* YesNo
*Required Field
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Please give the following information regarding your current and previous employers. Start with the most recent. Please explain any employment gaps
Employer*
Contact Name*
Phone*
Dates Employed* From* To*
Position*
Salary*
Reason for Leaving:*
Were you subject to the FMCSRs while employed?* YesNo
Was your job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?* YesNo
Employer
Contact Name
Phone
Dates Employed From To
Position
Salary
Address
Reason for Leaving:
Were you subject to the FMCSRs while employed? YesNo
Was your job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? YesNo
Please use this space for comments, additional information, or to explain periods of time between employers.
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State
License No
Type
Expiration Date
—Please choose an option—AlabamaAlaskaArizonaArkansasAmerican SamoaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasTrust TerritoriesUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Equipment Type
For How Long?
Total Miles
—Please choose an option—TractorTractor with Two TrailersStraight TruckOther
Have you ever been convicted, or are any charges pending: for driving while under the influence, possession, or sellling of alcohol, a narcotic drug, amphetamines or derivatives thereof? (DUI or DWI)* YesNo
Have you ever been denied a license, permit or privilege to operate a motor vehicle?* YesNo
Has any license, permit or privilege ever been suspended or revoked?* YesNo
Have you ever been refused any type of insurance or been denied bonding?* YesNo
Have you tested positive for a Pre-employment or Random or Post Accident drug or alcohol test?* YesNo
If yes, have you completed the SAP program?* YesNo
Have you ever abandoned your equipment?* YesNo
Have you ever been stopped while intoxicated?* YesNo
Have you ever been charged with a felony or misdemeanor?* YesNo If so, Dates State —Please choose an option—AlabamaAlaskaArizonaArkansasAmerican SamoaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasTrust TerritoriesUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Are you on probationor parole?* YesNo If so, Dates State —Please choose an option—AlabamaAlaskaArizonaArkansasAmerican SamoaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasTrust TerritoriesUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Criminal actions pending in which you are the defendant?* YesNo
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(List most recent first)
Date Injuries YesNo Fatalities YesNo Vehicle Type Describe
(Not parking violations)
Date Where? Violation Penalty
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Please provide the following information about completed education, starting with the most recent.
School or University
Years Completed
Field of Study
Graduate?
When
*
*YesNo
YesNo
Have you ever served inthe military? If so, when and what branch?*
Please list any training you have received that you think will benefit you in the position for which you are applying:
Please use the following space to list any experience or knowledge you have, not mentioned previously, special accomplishments, or comments you would like us to consider.
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Carefully Read the Following
By submitting this application, I certify that this employment application has been completed by me, and all of the entries provided are true, complete, and accurate, to the best of my knowledge. By submitting below I also authorize this company to make such inquires into my employment, financial, personal, criminal or medical history as might be needed to make an employment decision. I understand that information I provide regarding current and/or previous employers may be used, and those employers 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 inquiries into my medical history are generally made after a job offer is made. I hereby release my former employers, healthcare providers and schools from any and all liability in making response to these inquiries and from releasing the requested information. 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 that I am required to abide by all rules and regulations of the company.
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