Driver's Application for Employment - CMC Commodity TransportCMC Commodity Transport

Applicant Name

Date of Application

Address

City

State

Zip

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, 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 understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous 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(d) and (e). I understand I have the right to:

Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send 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.

Date

APPLICANT TO COMPLETE

Position(s) Applied for

Name

First Middle Last

Social Security No

Driver's License #*

DL Issuing State*

List your addresses of residency for the past 3 years.

Current Address

Street City State Zip Code

Phone

How Long?

Previous Addresses

Street City State Zip Code

How Long?

Street City State Zip Code

How Long?

Street City State Zip Code

How Long?

Do you have the legal right to work in the United States?

Date of Birth

Can you provide proof of age?

Have you worked for this company before?

Where?

Dates: From

To

Rate of Pay

Position

Reason for leaving

Are you now employed?

If not, how long since leaving last employment?

Who referred you?

Rate of pay expected

Have you ever been bonded?

Name of bonding company

Have you ever been convicted of a felony?

If yes, please explain fully on a seperate sheet of paper. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

If yes, explain if you wish.

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceeding 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 those 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

Name

Address City State Zip

Contact Person

Phone Number

Date From

Date To

Position Held

Salary/Wage

Reason for Leaving

Were you subject to the FMCSRs† while employed?

Yes
No

Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug And alcohol testing requirements of 49 cfr part 40?

Yes
No

EMPLOYMENT HISTORY (continued)

Name

Address City State Zip

Contact Person

Phone Number

Date From

Date To

Position Held

Salary/Wage

Reason for Leaving

Were you subject to the FMCSRs† while employed?

Yes
No

Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug And alcohol testing requirements of 49 cfr part 40?

Yes
No

* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, 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 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding

Accident Record for past 3 years or more (attach sheet if more space is needed) if none, write none

Dates

Nature of Accident

Fatalities

Injuries

Hazardous Material Spill

Traffic Convictions and forfeitures for the past 3 years (other than parking violations) if none, write none

Location

Date

Charge

Penalty

(ATTACH SHEET IF MORE SPACE IS NEEDED) EXPERIENCE AND QUALIFICATIONS - DRIVER

State

License No.

Type

Expiration Date

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes
No

B. Has any license, permit, or privilege ever been suspended or revoked?

Yes
No

If The Answer To Either A Or B Is Yes, Give Details

DRIVING EXPERIENCE CHECK YES OR NO

Straight Truck

Yes
No

Circle Type of Equipment

Dates From

Dates To

Approx. No. of Miles

Tractor and Semi-Trailer

Yes
No

Type of Equipment

Dates From

Dates To

Approx. No. of Miles

Tractor - Two Trailers

Yes
No

Type of Equipment

Dates From

Dates To

Approx. No. of Miles

Tractor - Three Trailers

Yes
No

Type of Equipment

Dates From

Dates To

Approx. No. of Miles

Motorcoach - School Bus

Yes
No

Type of Equipment

Dates From

Dates To

Approx. No. of Miles

Show special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help in your work for this company

List courses and training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

EDUCATION

Circle Highest Grade Completed

High School:

College:

Last School Attended

TO BE READ AND SIGNED BY APPLICANT

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.

Signature:

Date: