Apply Online

10%

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 for 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.

Driver's Application for Employment

Applicant Name*

Applicant Email*

Date of Application*

Company

Address

City

State

Zip

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.

20%

Applicant to Complete

Position Applied For*

Name (First & Last)*

Social Security No. (Last 4 Digits)*

List your addresses of residency for the past 3 years

Current Address

Street*

City*

State*

ZipCode

Phone*

How Long?*

Previous Address (Fill Previous Address only if current address is less than 3 years)

Street

City

State & ZipCode

How Long?

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

Have you ever been convicted of a felony?*

Date Of Birth (Required For Commercial Drivers)

Have You Worked For This Company Before?

Dates: From:

To:

Position:

Reason For Leaving:

Who Referred You?

Rate of Pay Expected

30%

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 addi-tional 7 years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

Employer

Name*

Address*

City*

State*

ZIP*

Contact Person*

Phone*

Were you subject To The FMCSRs While Employed*

Was Your Job Designated as a Safety-Senstive Function in any Dot-Regulated Mode Subject to the Drug and Alcohol Testing Requirements of 49 CFR Part 40?*

Date *

Employer 2

Name

Address

City

State

ZIP

Contact Person

Phone

Were you subject To The FMCSRs While Employed

Was Your Job Designated as a Safety-Senstive Function in any Dot-Regulated Mode Subject to the Drug and Alcohol Testing Requirements of 49 CFR Part 40?

Date

Employer 3

Name

Address

City

State

ZIP

Contact Person

Phone

Were you subject To The FMCSRs While Employed

Was Your Job Designated as a Safety-Senstive Function in any Dot-Regulated Mode Subject to the Drug and Alcohol Testing Requirements of 49 CFR Part 40?

Date

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 or 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.

40%

Declaration of Employment Status

Under Federal Motor Carrier Safety Regulations (391.23), Casual Driver Leasing Services is required to verify the preceding three years employment background for all prospective commercial drivers. If you were unemployed or self employed for more than thirty (30) consecutive days within the past three (3) years, complete this part and provide the required documentation.

Dates

From*:

To*:

From:

To:

From:

To:

From:

To:

From:

To:

During the date(s) specified above, the following statement(s) is/are true & correct. Check ALL that apply.

I was not employed anywhere on a full time or part time basis

I was self employed. (Attach documentation if driving for owner operator; provide proof of authority, DOT number, and proof of enrollment in a drug testing pool.)

I did collect money. (Unemployment, Disability, etc)

I did not collect money

I did not commit nor was I convicted of a crime.

I was not involved in a motor vehicle accident of any type.

I was not driving a commercial vehicle during the above dates.

I was unemployed due to:

50%

Accident Records

FOR THE PAST THREE YEARS OR MORE. IF NONE, CHECK THE BOX AT THE END OF THIS SECTION

LAST ACCIDENT

Dates

Nature Of Accident

Fatalities

Injuries

Hazardous Material Spill

NEXT PREVIOUS ACCIDENT

Dates

Nature Of Accident

Fatalities

Injuries

Hazardous Material Spill

NEXT PREVIOUS ACCIDENT

Dates

Nature Of Accident

Fatalities

Injuries

Hazardous Material Spill

NEXT PREVIOUS ACCIDENT

Dates

Nature Of Accident

Fatalities

Injuries

Hazardous Material Spill

No Accident Records In The Past Three Years

60%

Traffic Convictions

AND FORFEITURES FOR THE PAST THREE YEARS (OTHER THAN PARKING VIOLATIONS). IF NONE, CHECK THE BOX AT THE END OF THIS SECTION

TRAFFIC CONVICTIONS RECORD 1

Location

Date

Charge

Penalty

TRAFFIC CONVICTIONS RECORD 2

Location

Date

Charge

Penalty

TRAFFIC CONVICTIONS RECORD 3

Location

Date

Charge

Penalty

NO TRAFFIC CONVICTIONS IN THE PAST THREE YEARS

70%

Qualification - Driver

DRIVER LICENSES OR PERMITS IN THE PAST 3 YEARS

Issuer*

License No.*

Class

Endorsement(s)

Expiration Date

Issuer

License No.

Class

Endorsement(s)

Expiration Date

Issuer

License No.

Class

Endorsement(s)

Expiration Date

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

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

100%

Experience & Qualifications - Others

Show any trucking, transportation or other experience that may help in your work for this company

List courses & training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

Education

Select highest grade completed

High School

College

TO BE READ AND SIGNED BY THE 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, 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.

Signature

Date

Apply Online

TO BE READ AND SIGNED BY APPLICANT

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.

Applicant to Complete

List your addresses of residency for the past 3 years

Current Address

Previous Address (Fill Previous Address only if current address is less than 3 years)

Employment History

Employer

Date *

Employer 2

Date

Employer 3

Date

Declaration of Employment Status

Accident Records

Traffic Convictions

Qualification - Driver

Driving Experience

Experience & Qualifications - Others