Driver's Application For Employment

(Pre-Employment Application Questionnaire) (An Equal Opportunity Employer)

6622 112TH E. | Puyallup, WA 98373 | 1(888)565-5665 | Fax 253-435-5788

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job disability, or any other protected group status.

Date *
Date
Last, First, Middle
***-**-****
Date of birth *
Date of birth
required for Commercial Drivers
Present Address *
Present Address
Previous Address *
Previous Address
Phone Number *
Phone Number
Are you 18 years or older? *
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? *
Employment Desired
Date you can start. *
Date you can start.
Are you employed now? *
If so, can we inquire of your present employer?
Have you ever applied to this company before? *
From
From
To
To
(Answer only if a job requirement)
Education
Address
Address
Did You Graduate?
Address
Address
Did you graduate?
Address
Address
Did you graduate?
Address
Address
Did you graduate?
Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members
Branch
Former Employers
*Includes vehicles having a GVWR OF 26,OO1 LBS. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in quantity requiring placarding.
+The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to eransportpassengers 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 any size and is used toto transport hazardous materials a quantity requiring placarding
+ Have you ever been subject to the FMCSRs while employed? *
Did any of your jobs designate as a safety-sensitive function in any DOT- Regulated mode subject to the drug and alcohol testing requirements of 49CRF PART 40? *
If yes, explain if you wish.
All driver applicants to drive the interstate commerce must provide the following information on all employers during the preceding 3 years. List Complete mailing address, street number, city, state and zip code.
Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide 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.
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
From
From
To
To
Address
Address
Contact
Contact
Phone
Phone
Accident Record
For past 3 years or more, IF none, Write "NONE"
Date
Date
Date
Date
Date
Date
Traffic Convictions and forfeitures for the past 3 years
(Other than parking violations) If non, write "NONE"
Date
Date
Date
Date
Date
Date
Experience and Qualifications
List driver licenses or permits held in the past 3 years
Expiration
Expiration
Expiration
Expiration
Expiration
Expiration
Expiration
Expiration
A) Have you ever been denied a license, permit or motor vehicle? *
B) Has any license, permit or privilege ever been suspended or revoked? *
Driving Experience
Check yes or no
Straight Truck
From
From
To
To
Tractor and Semi-Trailer
From
From
To
To
Tractor - Two Trailers
From
From
To
To
Tractor - Three Trailers
From
From
To
To
Motor coach - School Bus
More than 8 passengers
From
From
To
To
Motor coach - School Bus
More than 15 passengers
From
From
To
To
References
Give the names of three persons not related to you, whom you have known for at least one year
Address
Address
Address
Address
Name
Address
Address
Emergency Contact Info
Phone
Phone
Address
Address
To be read and signed by applicant
I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, or MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND i AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHERMY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVES , OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR MAKEANY AGREEMENT CONTRARY TO THE FOREGOING.
I have read, understand and agree with the above paragraph *
Full Name
Date *
Date
To be read and signed by applicant
I authorize you to make such investigations and inquires 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 conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application 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) ADN I understand that 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 employer(s) and I cannot agree on the accuracy of the information
I have read, understand and agree with the above paragraph. *
Full Name
Date *
Date
This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by EEOC on July 26. 1991.