Employment Application Complete Name* Phone Number* Address* Street Address City State / Province / Region ZIP / Postal Code Date of Birth MM slash DD slash YYYY Total Years at this address Email Addresses for the past 3 yearsAddress Street Address City State / Province / Region ZIP / Postal Code Dates Address Street Address City State / Province / Region ZIP / Postal Code Dates REFERENCESList three references who know you. Name Address Telephone Name Address Telephone Name Address Telephone Submit verification of your identity and authorization to work in the United States. Do you have any restrictions or time limitations on your eligibility to work in the United States?Submit verification of your identity and authorization to work in the United States. Do you have any restrictions or time limitations on your eligibility to work in the United States? Yes No If YES, explain DOT REGULATIONS REQUIRE ALL DRIVERS TO BE ABLE TO SPEAK, READ AND WRITE THE ENGLISH LANGUAGE.DRIVER LICENSES State License No. Type Expiration Date MM slash DD slash YYYY Expiration Date State License No. Type Expiration Date MM slash DD slash YYYY Expiration Date State License No. Type Expiration Date MM slash DD slash YYYY Expiration Date(If more space is needed please attach an additional sheet and a copy of both sides of driver's license)A. Have you ever been deed a license, permit, or privelege to operate a motor vehicle?A. Have you ever been deed a license, permit, or privelege to operate a motor vehicle? Yes No B. Has any license, permit, or privilege ever been suspected or revoked?B. Has any license, permit, or privilege ever been suspected or revoked? Yes No If the answer to either A or B is YES, attach a statement giving details.DRIVING EXPERIENCEHiddenClass of EquipmentStraight Truck/Tank Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Truck Tractor Semi-Trailer Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Doubles Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Other Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY ACCIDENT RECORD FOR PAST 3 YEARSEntry 1 Dates Type of Accident Fatality Injury Entry 2 Dates Type of Accident Fatality Injury Entry 3 Dates Type of Accident Fatality Injury TRAFFIC CONVICTIONS FOR PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS)Entry 1 Location Date Offense Penalty Entry 2 Location Date Offense Penalty Entry 3 Location Date Offense Penalty (If more space is needed please attach an additional sheet)EMPLOYMENT RECORDNOTE: Show all employment for the past three years and all commercial driving experience for the past 10 years.Entry 1 Company Name Address Position PositionFrom MM slash DD slash YYYY FromTo MM slash DD slash YYYY ToReason for leaving Reason for leaving Supervisor Phone number Subject to FMCSR's(Federal Motor Carrier Safety Regulations) Yes No Subject to drug/alcohol testing requirements per 49 CFR part 40?Subject to drug/alcohol testing requirements per 49 CFR part 40? Yes No Entry 2 Company Name Address Position PositionFrom MM slash DD slash YYYY FromTo MM slash DD slash YYYY ToReason for leaving Reason for leavingSubject to FMCSR's(Federal Motor Carrier Safety Regulations) Yes No Subject to drug/alcohol testing requirements per 49 CFR part 40?Subject to drug/alcohol testing requirements per 49 CFR part 40? Yes No Entry 3 Company Name Address Position PositionFrom MM slash DD slash YYYY FromTo MM slash DD slash YYYY ToReason for leaving Reason for leavingSubject to FMCSR's(Federal Motor Carrier Safety Regulations) Yes No Subject to drug/alcohol testing requirements per 49 CFR part 40?Subject to drug/alcohol testing requirements per 49 CFR part 40? Yes No (Please attach additional sheets if neccessary)As a prospective employer, we must ask any applicant for a driving position with our company whether he/she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applied for, but did not obtain, "safety-sensitive transportation work" (driving a commercial motor vehicle) during these past three years.Have you been tested positive for drugs/alcohol or refused to take a pre-employment drug alcohol test in the three years preceding the date of this application?Have you been tested positive for drugs/alcohol or refused to take a pre-employment drug alcohol test in the three years preceding the date of this application? Yes No DOT regulations prohibit our utilizing you to perform a "safety-sensitive function" (driving a commercial motor vehicle). If you had a positive test, or a refusal to test, until and unless you provide documents showing successful completion of the return-to-duty process in accordance with DOT regulations.File UploadPlease attach any additional documents required. Drop files here or Select files Max. file size: 128 MB. TO BE READ AND SIGNED BY THE APPLICANTTHIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.Applicant's Signature* Date* MM slash DD slash YYYY 47008 Excellence in Motion Logistics and Transportation Services You Can Trust © 2024 Tum Logistics, All Rights Reserved. | Website by Weber & Co.
