Test Driver – Davis Cartage Co

Driver Application

To the Applicant: We appreciate your interest in our company and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgment, best meets your qualifications. We are an equal opportunity employer and shall consider qualified applicants for all positions without regard to race, color, sex, religion, national origin, age, martial or veteran status or disability.

Name(Required)

First Middle Last

Social Security Number(Required)

Phone(Required)

Email(Required)

Education(Required)

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Prior Address within Last 3 Years

Have you lived in more places over the last 3 years?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment History

Is it legal for you to work in the USA?

Can you prove your age?

In case of emergency notify(Required)

Have you worked with this company before?(Required)

Are you currently employed?(Required)

If not, how long since leaving your last job?(Required)

Did anyone refer you? If so, whom?(Required)

Ray of pay expected

Employment History(Required)

Employer

Position Held

Dates to and from

Reason for leaving

All driver applications: To drive a commercial vehicle for this company in intra/interstate commerce you must provide the following information on all employers during the preceding 10 years. (Note: List all employers in reverse order starting with the most recent first.)

Driving Record

Have you been in an accident in the last 5 years?(Required)

Driving Record(Required)

Dates

Nature of Accident

# Injured

# Fatalities

Accident record for past 5 years. Please indicate “none” if not applicable

Traffic Convictions in Past 5 Years(Required)

Do not include parking. Please indicate “None” if not applicable.

Traffic Convictions in the Past 5 Years(Required)

Locations

Date of Violation

Type of Violation

Penalty (PTS)

Do no include parking. Please indicate “none” if not applicable

Driving History

Driver's License(s)(Required)

State

License No.

Type

Expiration Date

Include your current state and any state held in the last 10 years

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

Yes

Has any license, permit or privilege even been suspended or revoked?(Required)

Yes

Have you ever held a driver's license in any state other than the license you are currently holding?(Required)

Yes

Have you ever pled guilty, accepted diversion or been convicted of any criminal offense other than a minor traffic violation? If so, please explain.(Required)

Yes

If you answered yes to any of the above questions, please provide more information here(Required)

Driving Experience(Required)

Class of Equipment

Type of Equipment

Dates

Approx Miles

Must have at least 2 years CDL driving experience, excluding school & military. Class of equipment could include van, tank, flat, etc.

List states operated in for the last five (5) years(Required)

List safe driving awards you have received(Required)

Consent & Signature

Consent(Required)

I agree that the information provided is true to the best of my abilities.

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:

Review information provided by current/previous employers;

Have errors in the information corrected by previous employers, and for those previous employers to resend 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.

If hired, I agree I will serve at the will of the Company, and I agree that I shall be bound by the rules, policies, regulations and terms and conditions of employment of the Company as they are from time to time changed with or without notice to me. I AGREE THAT EITHER PARTY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP, WITH OR WITHOUT CAUSE, AT ANY TIME. I agree that these arrangements may only be altered in writing directed to me personally by the President of the Company. I further agree that my employment is conditional upon satisfactorily completion of documentation as required by the Immigration Reform and Control Act of 1986 and until such time as the results of my employment physical (if such physical is required) are known.

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. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.