Class A & B CDL Truck Driver

EEO Statement

In compliance with Federal and State equal employment opportunity laws, qualified applicants яге considered for all positions without regard 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 employees) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand 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 employees) and I cannot agree on the accuracy of the information.
• Position(s) Applied for *
• First Name *
• Middle Name *
• Last Name *

List your addresses of residency for the past 3 years.

• Current Address
• Street *
• City *
• State *
• Phone *
• How Long? (yr./mo.) *
• Previous Addresses
• Street
• City
• How Long? (yr./mo.)
• Street
• City
• How Long? (yr./mo.)
• Street
• City
• How Long? (yr./mo.)

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

Conviction of a crime is not an automatic bar to employment - all circumstances will be considered

• 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]? If yes, explain if you wish. *

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

Applicants to drive a commercial motor vehicle
* intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (

NOTE:

List employers in reverse order starting with the most recent. Add another sheet as necessary.)

• * Includes vehicles having a GV WR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers 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 8 or more passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
• Accident Record (for past 3 years or more, if none - write none) *
• Traffic convictions and forfeitures for the past 3 years (if none- write none)
• Dates Nature of accident Fatalities Injuries Hazardous material spill
• Location Date Charge Penalty

List all driver licenses or permits hold in the past 3 years

S…