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.

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Date of Application _____________________

 

 

Position(s) Applied for ____________________________________________________________________________

Name                                                                                                                      Social Security No.                            

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List your addresses of residency for the past 3 years.

Current Address                                                                                                                                                                 

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                                Street                                                                                     City

                                                                                ________             Phone                                     How Long?         

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                                State                                       Zip Code

                                                                                                                                                                 How Long?         

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                                Street                                     City                                         State/Zip

    _____________________                                                                                                           How Long?         

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                                Street                                     City                                         State/Zip

    ____________                                                                                                                                                How Long?         

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                                Street                                     City                                         State/Zip

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

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

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Have you worked for this company before?                                    Where?                                                                

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Dates: From                          To                           Rate of Pay                           Position                                               

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Reason for leaving                                                                                                                                                             

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

Who referred you?                                                                                                Rate of pay expected?                      

 

 

 


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 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:

                                                                                                                                                                               
                                                                                                                                                                               

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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

 

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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