APPLICATION FOR EMPLOYMENT - Truck Drivers Information required on this form complies with U.S. Department of Transportation Regulations 49CFR§391.21. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, sexual orientation, national origin, age, marital status, or non-job related disability. RESET HOW DO YOU HERE ABOUT US?Job FairKST Contacted MeEmployee ReferralWebsiteCraigslistLinkedInFacebookAgencyReferred ByCONTACT INFORMATIONNAME* First Last TELEPHONE NUMBER*EMAIL ADDRESS* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code CLICK "Yes" IF YOU NEED TO PROVIDE ADDITIONAL ADDRESSES*YesNoMust show minimum of 3 years. Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code ADDITIONAL APPLICANT INFORMATIONARE YOU OVER 18 YEARS OF AGE?*YesNoDATE OF BIRTH*Required for truck drivers Date Format: MM slash DD slash YYYY CAN YOU PROVIDE PROOF OF AGE?*YesNoARE YOU A VETERAN OF THE U.S. MILITARY?*YesNoDO YOU HAVE THE LEGAL RIGHT TO WORK IN THE UNITED STATES?*YesNoHAVE YOU EVER BEEN CONVICTED OF A FELONY?*YesNoIf yes, please explain.DRIVING HISTORY and EXPERIENCELicense Class (Example: Class A)Drivers License #Expiration Date Date Format: MM slash DD slash YYYY State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific - License Class (Example: Class A)Drivers License #Expiration Date Date Format: MM slash DD slash YYYY State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific - License Class (Example: Class A)Drivers License #Expiration Date Date Format: MM slash DD slash YYYY State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific - LIST SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVERWHICH SAFE OPERATION AWARDS DO YOU HOLD AND FROM WHOM?TRAFFIC CONVICTIONS and FORFEITURES FOR THE PAST 3 YEARS(Other than parking violations)HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVILEGE TO OPERATE A MOTOR VEHICLE?*YesNoHAVE ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED?*YesNoIf the answer is YES to either question, please provide details.HAVE YOU HAD ANY TRAFFIC VIOLATION IN THE PAST 3 YEARS?*YesNoDate Date Format: MM slash DD slash YYYY Type of ViolationCommercial VehicleYesNoState AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific * Date Date Format: MM slash DD slash YYYY State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific * Type of ViolationCommercial VehicleYesNoDate Date Format: MM slash DD slash YYYY State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific * Type of ViolationCommercial VehicleYesNoACCIDENT RECORD FOR PAST 3 YEARSHAVE YOU BEEN IN AN ACCIDENT IN THE PAST 3 YEARS?*YesNoDate Date Format: MM slash DD slash YYYY DetailsFatalitiesYesNoType of InjuriesDate Date Format: MM slash DD slash YYYY DetailsFatalitiesYesNoType of InjuriesDate Date Format: MM slash DD slash YYYY DetailsFatalitiesYesNoType of InjuriesEMPLOYMENT HISTORYAll driver applications to drive in interstate commerce must provide the following information on all employers during the preceding three (3) years. Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional sever (7) information on those employers for whom the application operated such vehicle. UPLOAD YOUR RESUME - optionalThe file must be .docx, .doc, .pdf, or .txt.Start Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY CompanyPosition Held Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Reason for Leaving:Contact NameContact PhoneContact EmailWERE YOU SUBJECT TO THE FMCSR WHILE EMPLOYED?YesNoWERE YOU JOB SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF CFR Part 40?YesNoStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY CompanyPosition Held Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Reason for Leaving:Contact NameContact PhoneContact EmailWERE YOU SUBJECT TO THE FMCSR WHILE EMPLOYED?YesNoWAS YOU JOB SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF CFR Part 40?YesNoStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY CompanyPosition Held Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Reason for Leaving:Contact NameContact PhoneContact EmailWERE YOU SUBJECT TO THE FMCSR WHILE EMPLOYED?YesNoWAS YOU JOB SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF CFR Part 40?YesNoEMPLOYMENT - OtherHAVE YOU EVER BEEN DISMISSED OR FORCED TO RESIGN FROM ANY EMPLOYMENT?YesNoIf "yes", please explain:MAY WE CONTACT YOUR PRESENT EMPLOYER?YesNoMAY WE CONTACT YOUR PREVIOUS EMPLOYER?YesNoIS THERE ANY REASON YOU MIGHT BE UNABLE TO PERFORM THE FUNCTIONS OF THE JOB OF WHICH YOU HAVE APPLIED?YesNoIf "Yes", please explain if you wish:LIST ANY TRUCKING, TRANSPORTATION OF OTHER EXPERIENCE THAT MAY BE VALUABLE IN THIS POSITIONEDUCATIONSchool NameDegree TypeAssociates DegreeBachelors DegreeDoctorate DegreeHigh School / GEDCertificationMajor / CertificationsGraduation Date Date Format: MM slash DD slash YYYY School NameDegree TypeAssociates DegreeBachelors DegreeDoctorate DegreeHigh School / GEDCertificationMajor / CertificationsGraduation Date Date Format: MM slash DD slash YYYY School NameDegree TypeAssociates DegreeBachelors DegreeDoctorate DegreeHigh School / GEDCertificationMajor / CertificationsGraduation Date Date Format: MM slash DD slash YYYY LIST ADDITIONAL ANY JOB-RELATED SKILLS, QUALIFICATIONS, EDUCATION OR INFORMATION THAT SUPPORT YOUR APPLICATIONNOTICE TO APPLICANTThis Employer is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, sexual orientation, religion, national origin, disability, veteran or marital status, or any other status or condition protected by applicant’s federal or state statutes, except where a bona fide occupational qualification exists. Your opportunity for employment with the Employer depends solely upon your qualifications.NameThis field is for validation purposes and should be left unchanged.
