Date of Application:
Name (Last, First, Middle):
Social Security No.:
Current Address:
City:
State:
Zip:
Phone:
Prior Addresses within the Past 3 Years:
Street, City, State, Zip:
Street, City, State, Zip:
Is it legal for you to work in the USA?
Can you prove your age?
In case of emergency notify (Name, Address & Phone if Different:
Have you worked with this company before?
Date:
From
to
Position:
Reason for Leaving:
Are you employed now?
If not, how long since leaving your last job?
Who Referred you?
Rate of pay expected:
NOTE: DRIVERS WILL BE REQUIRED TO TAKE A DOT MEDICAL EXAMINATION INCLUDING A DRUG SCREEN. PLEASE COMPLETE THE RELEASE(S) ATTACHED TO THIS APPLICATION.
Employment History
(Past 10 years required)
All driver applications: to drive a commercial vehicle for this company in intra/interstate commerce you must provide the following information on all employers during the preceding 10 years. ( note: list all employers in reverse order starting with the most recent first.)
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Employer Name:
Address: (Street, City, State, Zip)
Phone:
Dates:
From
Position Held:
Reason for Leaving:
Driving Record
Accident record for past 5 years - Indicate "NONE" if not applicable
Last Accident Date:
Prev. Accident Date:
Prev. Accident Date:
Prev. Accident Date:
Traffic convictions in the past years (other than parking) - Indicate "NONE" if not applicable
Location:
Location:
Location:
Location:
Education: (Select the highest grade completed)
-
1
2
3
4
5
6
7
8
High School 1
High School 2
High School 3
High School 4
College 1
College 2
College 3
College 4
Last School Attended:
Driver's License(s)
Current License:
Other's held in the last 10 years:
State:
State:
A. Have you ever been denied a license, permit or priveledge to operate a Motor vehicle?
B. Has any license, permit or priveledge ever been suspended or revoked?
C. Have you ever held a driver’s license in any state other than the license
you are currently holding?
D. Have you ever pled guilty, accepted diversion or been convicted of any criminal offense other than a minor traffic violation? If so, please explain.
If the answer to either A, B, C or D is yes, give details below:
Driving Experience (Must have at least 2 years over-the-road experience) (Excluding school & military)
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
Class of Equip.:
-
Straight
Tractor/Trailer
Doubles
Multiple Axles (8)
Other
Type of Equip.:
List states operated in for last five (5) years:
List special courses or training that will help you as a driver:
List safe driving awards you have received:
Show any trucking, transportation or other experience that may help you in your work for this company:
List of courses and training other than shown elsewhere in this application:
List special equipment or technical materials you can work with other than already shown:
Other remarks or information you wish to provide:
In connection with my application for employment (including contract services) with you, I understand that an investigative consumer report is being requested from DAC Services, Tulsa, Oklahoma, that will include information as to my character, work habits, performance and experience, along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information concerning my driving record and/or information from various past employers, federal, state, and other agencies which maintain records concerning traffic offenses, accidents, etc., as well as information from DAC concerning (1) previous driving record requests made by others from such state agencies; (2) state provided driving records; (3) claims involving me in the files of insurance companies; (4) past criminal convictions.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC OR DAVIS CARTAGE CO, TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I have a right to make a written request within reasonable period of time to receive additional detailed information about the nature and scope of this investigation. I hereby consent to your obtaining the above information from DAC, and agree that such information which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC’s services.If hired, I agree I will serve at the will of the Company, and I agree that I shall be bound by the rules, policies, regulations and terms and conditions of employment of the Company as they are from time to time changed with or without notice to me. I AGREE THAT EITHER PARTY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP, WITH OR WITHOUT CAUSE, AT ANY TIME. I agree that these arrangements may only be altered in writing directed to me personally by the President of the Company. I further agree that my employment is conditional upon satisfactorily completion of documentation as required by the Immigration Reform and Control Act of 1986 and until such time as the results of my employment physical (if such physical is required) are known.
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.
Name:
