P.O. BOX 487 • ASHFORD, AL 36312

800-633-7590, ext.116 • Fax 334-899-8412

 

DRIVERS APPLICATION FOR EMPLOYMENT

            In compliance with Federal and State equal employment opportunity laws, qualified
 applicants  are considered for all positions without regards to race, color,
religion, sex, national origin, age, marital status, or non-job related disability.

Text Box:  

Text Box:  
 

Date of Application _____________________

 

 

Position(s) Applied for ____________________________________________________________________________

Name                                                                                                                      Social Security No.                            

Text Box:  
 

List your addresses of residency for the past 3 years.

Current Address                                                                                                                                                                 

Text Box:  

Text Box:  

 

                                Street                                                                                     City

                                                                                ________             Phone                                     How Long?         

Text Box: Previous Addresses
 

Text Box:  

 

Text Box:  

 

                                State                                       Zip Code

                                                                                                                                                                 How Long?         

Text Box:  
 

Text Box:  

 

                                Street                                     City                                         State/Zip

    _____________________                                                                                                           How Long?         

Text Box:  
 

Text Box:  

 

                                Street                                     City                                         State/Zip

    ____________                                                                                                                                                How Long?         

Text Box:  
 

                                Street                                     City                                         State/Zip

Text Box:  
 

Text Box:  

 

Do you have the legal right to work in the United States?                                                                                          

Text Box:  
 

Text Box:  

 

Date of Birth (required for commercial drivers)                                              Can you provide proof of age?        

Text Box:  
 

Text Box:  

 

Text Box:  

 

Text Box:  

 

Have you worked for this company before?                                    Where?                                                                

Text Box:  
 

Dates: From                          To                           Rate of Pay                           Position                                               

Text Box:  
 

Text Box:  

 

Reason for leaving                                                                                                                                                             

Text Box:  
 

Text Box:  

 

Are you now employed?                      If not, how long since last employment?                                                      

Who referred you?                                                                                                Rate of pay expected?                      

 

 

 


Text Box:  
 

 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, please explain if you wish:

                                                                                                                                                                               
                                                                                                                                                                               

___________________________________________________________________________
___________________________________________________________________________

 

EMPLOYMENT HISTORY

All driver applicants to drive in 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 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 most recent.
Add another sheet as necessary.)

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

EMPLOYER

DATE

NAME:

FROM(Mo./Yr)

 

TO (Mo/Yr)

 

ADDRESS:

POSITION HELD

 

CITY:

ST: 

ZIP: 

SALARY/WAGE

 

CONTACT PERSON:

PHONE:

REASON FOR LEAVING

 

*Includes vehicles having a GVWR of 26,001 lbs. Or more, vehicles designed to transport 15 or more passengers,
or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

 

 

Accident record for the past 3 years or more (attach sheet if more space is needed). If none, write none.

DATES

NATURE OF ACCIDENT

(HEAD-ON, REAR-END, UPSET, ETC.)

FATALITIES

INJURIES

Last Accident:

 

 

 

Next Previous:

 

 

 

Next Previous:

 

 

 

 

Traffic convictions and forfeitures for the past 3 years (other than parking violations). If none, write none.

LOCATION

DATE

CHARGE

PENALTY

 

 

 

 

 

 

 

 

 

 

 

 

(ATTACH SHEET IF MORE SPACE IS NEEDED)

 

EDUCATION

 

Text Box:  
 

Elementary (1-8):

High School (1-4):

College (1-4):



What is the highest grade level completed?

Last school attended:                                                                                                                                                             

                                                                                (NAME)                                                 (CITY)

 

EXPERIENCE AND QUALIFICATIONS – DRIVER

DRIVERS

LICENSES

STATE

LICENSE NO.

TYPE

EXPIRATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?                                    ____                _______________________________________________________________________________

B. Has any license, permit or privilege ever been suspended or revoked?                                            _____    ____                _______________________________________________________________________________

If the answer to either A or B is YES, attach a statement giving details.

 

DRIVING EXPERIENCE: IF NONE, WRITE NONE

CLASS OF EQUIPMENT

TYPE OF EQUIPMENT

FROM (MO/YR)

TO (MO/YR)

APPROX. NO. OF MILES (TOTAL)

Straight Truck

 

 

 

 

Tractor and Semi-Trailer

 

 

 

 

Tractor – Two Trailers

 

 

 

 

Motor Coach – School Bus

 

 

 

 

Other: 

 

 

 

 

 

Text Box:                                                                                      
 

List states operated in for the last five years:                                                                                                                               
                                                                                                                                                                ___________      _______                __________________________________________________________________________________

Show special courses or training that will help you as a driver:                                                                                               
                                                                                                                                                                                                _______

Which safe driving awards do you hold and from whom?                                                          ________             _______
____________________________________________________________________ _____________________

 

EXPERIENCE AND QUALIFICATIONS – OTHER

Show any trucking, transportation or other experience that may help in your work for this company:

____________________________________________________________________ _____________________

____________________________________________________________________ _____________________

____________________________________________________________________ _____________________

List courses and training other than shown elsewhere in this application:

____________________________________________________________________ _____________________

____________________________________________________________________ _____________________

____________________________________________________________________ _____________________

List special equipment or technical materials you can work with (other than those already shown):

____________________________________________________________________ _____________________

____________________________________________________________________ _____________________

 

TO BE READ AND SIGNED BY APPLICANT

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

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 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.

 

Applicant’s Signature                                                                                          Date                                                     

 


Text Box:  
 

Text Box:  

 PROCESS RECORD

Text Box:  
 

Text Box:  

 

Applicant Hired:                                                                                     Rejected:                                                            

Text Box:  
 

Text Box:  

 

Date Employed:                                                                                    Point Employed:                                                                

Department:                                                                                          Classification:                                                    

(If rejected, summary report of reasons should be placed in file)

 

THIS SECTION TO BE FILLED IN BY RESPONSIBLE OFFICER OR COMPANY REPRESENTATIVE

 

                                                    SUPERIOR GOOD      FAIR  BELOW AVG. POOR WRITTEN RECORD ON FILE

1. APPLICATION

 

 

 

 

 

 

2. INTERVIEW

 

 

 

 

 

 

3. PAST EMPLOYMENT

 

 

 

 

 

 

4. WRITTEN EXAM

 

 

 

 

 

 

5. ROAD TEST

 

 

 

 

 

 

6. CRIMINAL AND TRAFFIC CONVICTIONS

 

 

 

 

 

 

Text Box:  
 

Signature of interviewing officer:                                                                                        

TRANSFERS

FROM:

TO:

FROM:

TO:

DATE:

DATE:

REASON:

REASON:

FROM:

TO:

FROM:

TO:

DATE:

DATE:

REASON:

REASON:

TERMINATION OF EMPLOYMENT

Date Terminated:

From department:

Supervisor:

Dismissed:

Voluntarily Quit:

Other: