Job Application

Your Information

Have you worked for this company before?
Are you a citizen of the United States?
Are you authorized to work in the U.S.?
Have you ever been denied a license, permitor privilege to operate a motor vihicle?
Is there any reason you might be unable to perform the functions of job of which you have applied?
Have you ever been convicted of felony?
Are you currently serving probation or any deferred adjudication for a criminal offense?

Your Education

Do you have a high school diploma or GED?

Additional Schools Beyond High School

Your Work History

Please provide your employment data for the last seven years. List your current or most recent position first.

May we contact your present employer at this time?
Have you ever been discharged or requested to resign?
Were you subject to the FMCSRs while employed here?
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?

Driving Experience

Accidents reported in the last three years

Traffic Convictions and Forfeitures for the last three years (other than parking violations)

References

Please list three work and/or education related references. Do not list friends or relatives.

Agreement

It is agreed and understood that any misrepresentation given on this document shall be considered an act of dishonesty.

It is agreed and understood that the motor carrier or his agents may investigate my background to ascertain any and all information of concern to commercial driving record, whether same is of record or not, And I release the emplovers and persons named herein from all liability for any damages on account of their furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been old that this investigation may include an investigating Consumer Report, including information regardins my character, general reputation, personal characteristics, and mode of living.

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

My typed first and last names below shall have the same force and effect as my written signature.