CD Terminal Truck Driving Application, Truck Driving Jobs Winona

Applicant Name

Application Date*

Company

Address

Street Address City State / Province / Region ZIP / Postal Code

In compliance with Federal and State equal 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 results 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 employers(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 that 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.

Signature

APPLICANT TO COMPLETE

(answer all questions)

Position(s) Applied for

Name

First Middle Last

List your addresses of residency for the past 3 years.

Current Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

How Long?

yr./mo.

Previous Addresses

Street	City	State & Zip Code	How Long? (yr./mo.)

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

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?

How long since leaving last employment?

Who referred you?

Rate of pay expected

Have you ever been bonded?

(Answer only if a job requirement)

Name of bonding company

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]

Explain if you wish.

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 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.)

Employer Name

Address

Street Address City State ZIP Code

Date From (mo./yr.)

To

Contact Person

Phone Number

Position Held

Salary / Wage

Reason for Leaving

Were you subject to the FMCSRs¹ while employed?

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?

Employer Name

Address

Street Address City State ZIP Code

Date From (mo./yr.)

To

Contact Person

Phone Number

Position Held

Salary / Wage

Reason for Leaving

Were you subject to the FMCSRs¹ while employed?

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?

Employer Name

Address

Street Address City State ZIP Code

Date From (mo./yr.)

To

Contact Person

Phone Number

Position Held

Salary / Wage

Reason for Leaving

Were you subject to the FMCSRs¹ while employed?

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?

Employer Name

Address

Street Address City State ZIP Code

Date From (mo./yr.)

To

Contact Person

Phone Number

Position Held

Salary / Wage

Reason for Leaving

Were you subject to the FMCSRs¹ while employed?

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?

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

¹The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers and property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident records for the past 3 years or more. If none, write none.

Date	Nature of Accident (head-on, rear-end, upset, etc.)	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

Experience and qualifications - driver

Driver licenses or permits held in the past 3 years.

State	License Number	Class	Endorsement(s)	Expiration Date

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

Give details:

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

Give details:

Driving Experience

Straight Truck

Type of equipment

From (month/year)

To (month/year)