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DRIVER’S APPLICATION FOR EMPLOYMENT

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

Step 1 of 4 - Education / Experience

25%

Position Applied For*
Name*
FirstLast
Phone*
Email*
Enter EmailConfirm Email
Social Security No.*
Address*
Street AddressCityStateZip Code
How Long at address?*
Address
Street AddressCityStateZip Code
If you have been at your current address for less than 3 years please provide your previous address.
Do you have the legal right to work in the United States?*
Have you ever been convicted of a felony?*
If yes you will be asked date of conviction and explanation of offense.
Date of Birth*

(Question required for truck drivers)
Can you provide proof of age?*
- Yes
- No
Have you ever been employed by Casual Driver Leasing Services?*
- No
- Yes
When did you first work for Casual Driver Leasing Services?
Last date worked for Casual Driver Leasing Services
Please list your position, rate of pay, location and reason for leaving Casual Driver Leasing Services.
Are you currently employed?*
- Yes
- No
How long since leaving last employment?
Who referred you?
Rate of pay expected*
Who do we notify in case of an emergency?*
FirstLast
Phone number for emergency contact*
Is there any reason you might be unable to perform the functions of the job for which you have applied?*
- No
- Yes
Please explain.
Date of Conviction and Description of Offense

Applicants to drive commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years information on those employers from whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. )
Employer*
Start Date*
End Date*
Employer Address
Street AddressCityStateZip Code
Position Held*
Salary / Wage*
Reason for leaving
Name of Contact Person
FirstLast
Phone No.
Next Employer
Employer*
Start Date
End Date
Address
Street AddressCityStateZip Code
Position Held
Salary / Wage
Reason for leaving
Name of Contact Person
FirstLast
Next Employer
Phone
Employer
Start Date
End Date
Employer Address
Street AddressCityStateZip Code
Position Held
Salary / Wage
Reason for leaving
Name of Contact Person
FirstLast
Phone No.

Have you had any accidents in the last 3 years?*
- Yes
- No
If so you will be asked to describe each incident.
Date of last accident
Nature of accident
List any injuries or fatalities
Do you need to add an additional accident?
- Yes
- No
Date of accident
Nature of accident
List any fatalities or injuries
Do you have any additional accidents?
- Yes
- No
Do have any traffic convictions and forfeitures for the past 3 years? (Other than parking violations)*
Date of Offense
Location
Charge
Penalty
Additional offenses?
Date of offense
Location of offense
Charge
Penalty
Education
Highest Grade Completed *
Last school attended
Please enter name and city of school.

Drivers License Information
Please enter state, License No., Type, and Expiration date.
Additional Drivers License
Please enter state, License No., Type, and Expiration date.
Additional Drivers License
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
- No
- Yes
Has any license, permit or privilege ever been suspended or revoked?
- No
- Yes
Please provide a statement giving details.
Driving Experience
For each class of equipment with experience please indicate dates driver and approximate number of miles.
What class of vehicles do you have experience operating.
- Straight Truck
- Tractor and Semitrailer
- Tractor - Two Trailers
- Motorcoach - School Bus
- Other / Not Listed
Check all that apply
Straight Truck - First date of operation
Straight Truck - Last date operated
Straight Truck - approx. miles driven
Tractor and Semitrailer - First date operated
Tractor and Semitrailer - Last date operated
Tractor and Semitrailer - apporx. miles driver
Tractor - Two Trailers - First date of operation
Tractor - Two Trailers - Last date operated
Tractor - Two Trailers - approx. miles driver
Motorcoach / School Bus - First date of operated
Motorcoach / School Bus - Last date operated
Motorcoach / School Bus approx. miles driven
Other vehicle type
Please list experience with any other vehicle type not listed. make sure to include type of vehicle, dates and approx. miles driven
List all states you have operated in for the past 5 years
Show special courses or training completed that will help you as a driver
Which safe driving awards do you hold and from who?
Show any trucking, transportation or other experience that may help in your work for this company
List course and training other than shown elsewhere in the application
List special equipment or technical materials you can work other than those already shown.
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, 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 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.
Please type your full name to indicate you understand the above terms.
This acts as your electronic signature and is legally binding.
Todays Date
Name
This field is for validation purposes and should be left unchanged.

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DRIVER’S APPLICATION FOR EMPLOYMENT

Step 1 of 4 - Education / Experience

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