Company Driver Application Form
Date of Birth :
Position(s) Applied for
Current and Two (2) Years Previous Addresses
Do you have the legal right to work in the United States?
Can you provide proof of your age?
Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the standard job description]?
If Yes, explain if you wish
Complete Record of all employment for the past three years, including any unemployment or self employment, and all commercial driving experience for the past ten years.
List States Operated in for the last five (5) years.
Show Special Courses or Training that will help you as a driver
Accident Record for the past three (3) years
Traffic Convictions and Forfeitures for the last three years (other than parking violations)
Driver's License(list each driver's license held in the past three years)
Have you ever been convicted of a crime in the last 10 years?
If the answer to question is
YES, give details:
Have you ever tested positive on, or refused, any pre-employment drug or alcohol test during the past two years?
Have you ever been convicted of a DUI or other alcohol or drug related offense in the last 10 years?
Select Highest grade completed
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.
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, inquires 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.
(acts as signature)
Please fill out this form and include it as an email attachment to firstname.lastname@example.org: