262-895-4800

Family Owned & Operated

262-895-4800 | Text “Trash” to 44944 to Pay Your Bill

 

DRIVER EMPLOYMENT APPLICATION

(COMPANY NAME, ADRESS, PHONE NUMBER, EMAIL) An equal opportunity employer

COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED

APPLICANT INFORMATION

PREVIOUS THREE YEARS RESIDENCY
LICENSE INFORMATION

No person who operates a commercial motor vehicle shall have at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than motor vehicle license, the information that is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

PREVIOUSLY HELD LICENSES
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DRIVING EXPERIENCE
CLASS OF EQUIPMENT
TYPE OF EQUIPMENT (VAN TANK, FLAT, ETC.)
DATE FROM
DATE TO
APPROX # OF TOTAL MILES
STRAIGHT TRUCK
TRACTOR & SEMI-TRAILER
TRACTOR & 2 TRAILERS
TRACTOR & TANKER
OTHER
ACCIDENT RECORD FOR THE PAST 3 YEARS

Attach additinal sheets if more space is needed

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TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

Attach additional sheet if additional space is needed

If yes, please explain:
If yes, please explain:
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EMPLOYMENT HISTORY

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) requires that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years. Any gaps in employment in excess of one (1) month must be explained.


Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). you are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.


CURRENT (MOST RECENT) EMPLOYER
SECOND MOST RECENT EMPLOYER
THIRD MOST RECENT EMPLOYER
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EDUCATION
School
High School
College
Course of Study
Years Completed
Graduated
Any other Details
TO BE READ AND SIGNED BY APPLICANT

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 on my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.


I understand that the information I provide regarding my current and/or prior employers may be used, and that those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have a right to:

  • Review information provided by current/previous employers;

    • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective emoyer; and

    • Have a rebuttal statement attached to the alleged erroneous information, if previous employer(s) and I can not agree on the accuracy of the information


    This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require the applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Applicant Signature
Applicant Name (printed)