After filling out Online Form Please print PDF application and Bring the Section indicated for former employer on day of interview thank you. |
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If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered |
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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 or interstate commerce shall also provide an additional 7 years' information on thos employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.) |
EMPLOYER 1 |
DATE |
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EMPLOYER 2 |
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EMPLOYER 3 |
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EMPLOYER 4 |
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EMPLOYER 5 |
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EMPLOYER 6 |
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EMPLOYER 7 |
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* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), 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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in requiring placarding. |
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ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE(EMAIL IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE |
DATES |
NATURE OF ACCIDENT (HEAD-ON,REAR-END,UPSET,ETC) |
FATALITIES |
INJURIES |
HAZARDOUS MATERIAL SPILL |
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TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE |
LOCATION |
DATE |
CHARGE |
PENALTY |
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DRIVER LICENSES |
STATE |
LICENSE NO. |
TYPE |
EXPIRATION DATE |
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A. Have you ever been denied a license,permit or privilege to operate a motor vehicle? |
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B. Has any license, permit or privilege ever been suspended or revoked? |
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IF THE ANSWER TO EITHER A OR B IS YES , GIVE DETAILS |
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DATES |
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APROX. NO. OF MILES (TOTAL) |
DRIVING EXPERIENCE(TYPE YES OR NO) |
TYPE OF EQUIPMENT |
TO(M/Y) |
FROM(M/Y) |
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STRAIGHT TRUCK |
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TRACTOR AND SEMI-TRAILER |
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TRACTOR-TWO TRAILERS |
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TRACTOR-THREE TRAILERS |
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MOTORCOACH-SCHOOLBUS (more than 8 passengers) |
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MOTORCOACH-SCHOOLBUS (more than 15 passengers) |
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OTHER |
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LIST STATES OPERATED IN FOR LAST FIVE YEARS: |
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SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER |
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WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM? |
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EXPERIANCE AND QUALIFICATIONS |
SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY |
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LIST COURSES AND TRAINING OTHER THAT SHOWN ELSEWHERE IN THIS APPLICATION: |
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LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN) |
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HIGHEST GRADE COMPLETED |
ELEMENTARY |
HIGH SCHOOL |
COLLEGE |
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LAST SCHOOL ATTENDED |
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( HTML Form )
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