Application for Employment - Truck Driver

Submitted by SchwebAdmin on Wed, 03/11/2020 - 15:49

Company

Name

Street Address

City

State

Zip

Personal Information

First Name *

Middle Name *

Maiden Name (if any)

Last Name *

Address

Street Address *

City *

State *

Zip *

How long? *

Date of Birth *

Month

Day

Year

Hire Date *

Month

Day

Year

Phone Number *

Email Address *

Previous Three Years Residency

Residency

Street Address

City

State

Zip

Number of Years

Residency

Street Address

City

State

Zip

Number of Years

Residency

Street Address

City

State

Zip

Number of Years

License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

State *

License No. *

Type *

Expiration Date *

Month

Day

Year

Driving Experience

Straight Truck

Type of Equipment (Van, Tank, Flat, etc.)

Date From

Date To

Approx. No. of Miles (Total)

Tractor and Semi-Trailer

Type of Equipment (Van, Tank, Flat, etc.)

Date From

Date To

Approx. No. of Miles (Total)

Tractor - Two Trailers

Type of Equipment (Van, Tank, Flat, etc.)

Date From

Date To

Approx. No. of Miles (Total)

Other

Type of Equipment (Van, Tank, Flat, etc.)

Date From

Date To

Approx. No. of Miles (Total)

Accident Record for Past 3 Years or More

Do you have any accidents on your record? *

Yes

No

Accident

Date *

Nature of Accident (Head-on, Rear-end, Upset, etc.) *

Number Fatalities *

Number Injuries *

Chemical Spills *

Yes

No

Accident

Date

Nature of Accident (Head-on, Rear-end, Upset, etc.)

Number Fatalities

Number Injuries

Chemical Spills

Yes

No

Accident

Date

Nature of Accident (Head-on, Rear-end, Upset, etc.)

Number Fatalities

Number Injuries

Chemical Spills

Yes

No

Traffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)

Do you have any violations on your record? *

Yes

No

Violation

Date Convicted (month/year) *

Violation *

State of Violation Location *

Penalty (forfeited bond, collateral and/or points) *

Violation

Date Convicted (month/year)

Violation

State of Violation Location

Penalty (forfeited bond, collateral and/or points)

Violation

Date Convicted (month/year)

Violation

State of Violation Location

Penalty (forfeited bond, collateral and/or points)

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

Yes

No

If yes, explain *

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

Yes

No

If yes, explain *

For current lumber and mulch prices

Application for Employment - Truck Driver

King's Sawmill