Employment Application

Driver Application for Employment

Applicants must be at least 23 years of age with 6 months verifiable OTR experience

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Note: As you are filling out this form, use the [Tab] key or the mouse to move between fields. Please do not hit the [Enter] or [Return] keys to move between fields as this will send the form prematurely. If you accidentally hit one of these keys, wait for an error message to display and click on the back arrow on your browser toolbar to return to and finish completing the form.

General Information

Position Desired Long Haul Driver
Office
Local Driver
Shop
Owner Operator

Owner Operator Tractor Information

Year: Make: Model: Weight:

Tandem: YesNo Sleeper:YesNo

Date of Application:

Referral Source:

Advertisement Employee Relative Employment Agency

Walk-in Private Employment Agency Other

Personal Information

Last Name: First: M.I.:

Address:

City:
State: Zip Code:

Date of Birth:

Home Phone:
Mobile/Beeper/Other Phone:

Social Security Number:

If necessary, best time to call you at home:

May we call you at work?YesNo

If yes, work number and best time to call:

Have you submitted an application here before? Yes If yes, when?

Date available for work:

List each Driver's License held in the last 3 years:

Driver's License Number:
State:

Driver's License Number:
State:

Driver's License Number:
State:

Employment Information

Give a COMPLETE RECORD of all employment in the past 3 years, starting with the most recent, and all commercial driving experience for the past 10 years. Explain any gaps in employment in the comments section below.

Most Recent Employer

Employer:

Address:

City:

State:
Zip Code:

Phone:

Supervisor:

May we contact?
Yes

Dates Employed:
to

Position:

Ending Pay Rate:

Responsibilities:

Reason for Leaving:

Second Most Recent Employer

Employer:

Address:

City:

State: Zip Code:

Phone:

Supervisor:

May we contact?
Yes

Dates Employed:
to

Position:

Ending Pay Rate:

Responsibilities:

Reason for Leaving:

Third Most Recent Employer

Employer:

Address:

City: State: Zip Code:

Phone:

Supervisor: May we contact? Yes

Dates Employed:
to

Position:

Ending pay Rate:

Responsibilities:

Reason for Leaving:

Fourth Most Recent Employer

Employer:

Address:

City: State: Zip Code:

Phone:

Supervisor: May we contact? Yes

Dates Employed:
to

Position:

Ending Pay Rate:

Responsibilities:

Reason for Leaving:

Fifth Most Recent Employer

Employer:

Address:

City:

State:
Zip Code:

Phone:

Supervisor: May we contact? Yes

Dates Employed:
to

Position:

Ending Pay Rate:

Responsibilities:

Reason for Leaving:

Comments (include explanation of any gaps in employment):

Skills and Qualifications: Summarize any special training, skills, license and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Safety Record

Please list any Safe Driving Awards that you hold and from whom:

Please give details of any accidents in which you were involved in the last 3 years. Include dates, nature of accident (head on, rear-end, upset, etc.), number of injuries, number of fatalities. If none, type "NONE."

Please give details of all traffic convictions and forfeitures for the last 3 years. If none, type "NONE."

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? NoYes

If "yes," please give details in the box below.

Has any license, permit, or privilege ever been suspended or revoked? No Yes

If "yes," please give details in the box below.

Have you ever been convicted of a felony? No Yes

If "yes," please give details in the box below.

References

List name and telephone number of 3 business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list 3 school or personal references who are not related to you.

Reference 1

Name:

Phone:

Years Known:

Reference 2

Name:

Phone:

Years Known:

Reference 3

Name:

Phone:

Years Known:

List any additional information you would like us to consider.

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement of contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

Final employment offer is contingent upon passing physical and drug and alcohol screen. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Name (required):

E-mail (required):

An Equal Opportunity Employer

Driver Application for Employment
Applicants must be at least 23 years of age with 6 months verifiable OTR experience Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. Note: As you are filling out this form, use the [Tab] key or the mouse to move between fields. Please do not hit the [Enter] or [Return] keys to move between fields as this will send the form prematurely. If you accidentally hit one of these keys, wait for an error message to display and click on the back arrow on your browser toolbar to return to and finish completing the form.
General Information
Position Desired	Long Haul Driver Office	Local Driver Shop	Owner Operator
Owner Operator Tractor Information
Year:	Make:	Model:	Weight:
Tandem: YesNo		Sleeper:YesNo
Date of Application:
Referral Source:
Advertisement	Employee	Relative	Employment Agency
Walk-in	Private Employment Agency		Other
Personal Information
Last Name:		First:	M.I.:
Address:

City:		State:	Zip Code:
Date of Birth:
Home Phone:		Mobile/Beeper/Other Phone:
Social Security Number:
If necessary, best time to call you at home:
May we call you at work?YesNo
If yes, work number and best time to call:
Have you submitted an application here before?		Yes	If yes, when?
Date available for work:
List each Driver's License held in the last 3 years:
	Driver's License Number:		State:
	Driver's License Number:		State:
	Driver's License Number:		State:
Employment Information
Give a COMPLETE RECORD of all employment in the past 3 years, starting with the most recent, and all commercial driving experience for the past 10 years. Explain any gaps in employment in the comments section below.
Most Recent Employer
Employer:
Address:

City:	State:		Zip Code:
Phone:
Supervisor:		May we contact?	Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Second Most Recent Employer
Employer:
Address:

City:	State:		Zip Code:
Phone:
Supervisor:		May we contact?	Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Third Most Recent Employer
Employer:
Address:

City:	State:		Zip Code:
Phone:
Supervisor:		May we contact? Yes
Dates Employed:	to
Position:		Ending pay Rate:
Responsibilities:
Reason for Leaving:
Fourth Most Recent Employer
Employer:
Address:

City:	State:		Zip Code:
Phone:
Supervisor:		May we contact? Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Fifth Most Recent Employer
Employer:
Address:

City:	State:		Zip Code:
Phone:
Supervisor:		May we contact? Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Comments (include explanation of any gaps in employment):

Skills and Qualifications: Summarize any special training, skills, license and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Safety Record
Please list any Safe Driving Awards that you hold and from whom:

Please give details of any accidents in which you were involved in the last 3 years. Include dates, nature of accident (head on, rear-end, upset, etc.), number of injuries, number of fatalities. If none, type "NONE."

Please give details of all traffic convictions and forfeitures for the last 3 years. If none, type "NONE."

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? NoYes
If "yes," please give details in the box below.

Has any license, permit, or privilege ever been suspended or revoked? No Yes
If "yes," please give details in the box below.

Have you ever been convicted of a felony? No Yes
If "yes," please give details in the box below.

References
List name and telephone number of 3 business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list 3 school or personal references who are not related to you.
Reference 1
Name:
Phone:
Years Known:
Reference 2
Name:
Phone:
Years Known:
Reference 3
Name:
Phone:
Years Known:
List any additional information you would like us to consider.

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.
I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.
The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.
This application is current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement of contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.
I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.
I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
Final employment offer is contingent upon passing physical and drug and alcohol screen. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Name (required):
E-mail (required):
An Equal Opportunity Employer