Drivers Application | John F. Martin & Sons

Applicant Name

Date of Application

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 to 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 49CFR 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 alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Signature (Enter Full Name as Signature)

Date

Position(s) Applied for

Last Name

First Name

Middle Name

Phone

List your addresses of residency for the past 3 years.

Current Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

How Long At Current Address

Year/Month

Previous Address 1

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

How Long At Previous Address 1

Year/Month

Previous Address 2

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

How Long At Previous Address 2

Year/Month

Previous Address 3

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

How Long At Previous Address 3

Year/Month

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

Date of Birth

(Required for Commercial Drivers)

Can you provide proof of age?

Have you worked for this company before?

Where?

From

--- License 1 ---

Position

Reason for Leaving

--- Last Accident Date ---

Nature Of Accident

(HEAD ON, REAR-END, UPSET, ETC.)

Fatalities

Injuries

Hazardous Material Spill

Who referred you?

Rate of pay expected

Have you ever been bonded?

(Answer only if a job requirement)

Name of bonding company

Have you ever been convicted of a felony?

If yes, please explain fully. 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 job description)?

If yes, explain if you wish.

-----EMPLOYMENT HISTORY-----

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.

*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.

-----Most Recent-----

Employer

Contact Person

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

From

Position Held

Salary/Wage

Reason for leaving

Were you subject to the FMCSRs* 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?

-----Previous-----

Employer

Contact Person

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

From

Position Held

Salary/Wage

Reason for leaving

Were you subject to the FMCSRs* 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?

-----Previous-----

Employer

Contact Person

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

From

Position Held

Salary/Wage

Reason for leaving

Were you subject to the FMCSRs* 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?

-----Previous-----

Employer

Contact Person

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

From

Position Held

Salary/Wage

Reason for leaving

Were you subject to the FMCSRs* 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?

--- Conviction/Forfeiture 1 ---

Location

Date

Charge

Penalty

--- Previous Accident Date ---

Nature Of Accident

(HEAD ON, REAR-END, UPSET, ETC.)

Fatalities

Injuries

Hazardous Material Spill

TRAFFIC CONVICTIONS AND FOREITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

--- Conviction/Forfeiture 2 ---

Location

Date

Charge

Penalty

--- Conviction/Forfeiture 3 ---

Location

Date

Charge

Penalty

Add any additional conviction and forfeiture information

List all driver licenses or permits held in the past 3 years

State

License No.

Type

Expiration Date

--- License 2 ---

State

License No.

Type

Expiration Date

--- License 3 ---

State

License No.

Type

Expiration Date

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

B) Has any license, permit or privilege over been suspended or revoked?

If the answer to either A or B is yes, give details:

Driving Experience

List states operated in for last five years:

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

Which safe driving awards do you hold and from whom?

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)

Highest Grade Completed

High School

College

Last School Attended

Name

City/State

Comments

Add Resume

.pdf,.doc,.docx,.txt,.rtf
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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 (Enter Full Name as Signature)

Date / Time *