are interested in your well being, a physical examination
is required during employment at the discretion of the Company.
work experience/employment history
All applicants to driver in interstate commerce must
provide the following information on all employers during the preceding 3
years. list complete info. applicants to drive a commercial motor vehicle
(includes vehicles having a gvwr of 26,001 LBS. or more.
Vehicles designed to transport hazardous materials in intrastate or interstate
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 THE
please list all motor vehicle collisions in which you were
(both commercial and private vehicle)
during the past three years prior to the application date.
here if you had no collisions in the past three years.
traffic convictions and forfeitures
please list all traffic convictions and/or forfeitures
(both commercial and private vehicle) for the past
three years (other than parking).
here if you had no traffic violations in the past three years.
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 applicant applied for, but did not
obtain, "safety-sensitive transportation work" (driving a commercial motor
vehicle) during the past three years.
you must check either yes or no to one of the following
I have 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.
I have not tested positive for drugs/alcohol, or refused to take a
pre-employment drug/alcohol test in the three years preceding the date of this
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.
must be read and signed by the applicant
391.21 THIS 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.
I authorize the carrier to make such inquiries and
investigations of my personal, employment, driving, financial or medical
history and other related matters as may be necessary in arriving at an
employment decision. (Generally, inquiries regarding medical history will be
made only if and after a conditional offer of employment has been extended.) 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 agree to abide by the rules and regulations of the carrier as well
as the Federal Motor Carrier Safety Regulations. I also agree and understand
that if I am selected to drive for the carrier that I will be on a probationary
period during which time I may be discharged without recourse.
here if you agree to the above terms and conditions.