DRIVERS APPLICATION FOR EMPLOYMENT

Company ___________________________________________________________________

Address ____________________________________________________________________

City ________________________________ State ______________ Zip Code ____________

(answer all questions - please print)

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, veteran status, non-job related disability, or any other protected group status.

Date of Application _________________

 

Position(s) Applied for __________________________________________________________________________________________________________

Name (Last, First, Middle) _____________________________________________             Social Security Number _________________________________

List your addresses of residency for the past 3 years.

Current Address ____________________________________________________________________________________________________________

Phone Number ______________________________________________________            How Long? _______________

Previous Address ____________________________________________________________________________________________________________

Phone Number ______________________________________________________            How Long? _______________

Previous Address ____________________________________________________________________________________________________________

Phone Number ______________________________________________________             How Long? _______________

 

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? _______________________________________________________

Dates:    From ______________________    To __________________            Rate of Pay ________________                 Position _____________________

Reason For Leaving ___________________________________________________________________________________________________________

Are you Now Employed? _____________        If not, how long since leaving last employment? ___________________________________________________

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 attached job description)? _____________

If yes, explain if you wish _______________________________________________________________________________________________________


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 commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.

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

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

EMPLOYER

DATE

Name: From:  Month          Year                   To:  Month          Year
Address: Position Held:
City:                                                        State:                      Zip: Salary/Wage:
Contact Person:                                       Phone Number: Reason For Leaving:

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.


ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED). IF NONE, WRITE NONE.

DATES

NATURE OF ACCIDENT (head on, rear-end, upset, etc)

FATALITIES

INJURIES

Last Accident

 

     
Next Previous

 

     
Next Previous

 

     

 

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

LOCATION

DATE

CHARGE

PENALTY

       
       
       

(ATTACH SHEET IF MORE SPACE IS NEEDED)

 

EDUCATION

 

Circle Highest Grade Completed:     1    2    3    4    5    6    7    8               High School:    1    2    3    4               College:    1    2    3    4

Last School Attended (Name and City) _____________________________________________________________________________________________

 

Experience & Qualifications - Driver

  STATE LICENSE NO. TYPE EXPIRATION DATE
Drivers Licenses        
         
         

A.    Have you ever been denied a license, permit or privilege to operate a motor vehicle?                                       Yes __________        No __________

B.    Has an license, permit or privilege ever been suspended or revoked?                                                               Yes __________        No __________

If the answer to either A or B is yes, please explain ____________________________________________________________________________________

___________________________________________________________________________________________________________________________

 

DRIVING EXPERIENCE - IF NONE, WRITE NONE

CLASS OF EQUIPMENT

TYPE OF EQUIPMENT    (van, tank, flat, etc.)

DATES

From

 

To

APPROX. NO OF MILEs (Total)

Straight Truck        
Tractor & Semi-Trailer        
Tractor - Two Trailers        
Motor Coach - School Bus        
Other        

 

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? _________________________________________________________________________________


EXPERIENCE & QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help 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) __________________________________________________

___________________________________________________________________________________________________________________________

 

===========================================================================================================================

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, 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 of the Company.

Date ____________________                                                        Applicant's Signature ______________________________________________________

===========================================================================================================================

PROCESS RECORD

Applicant Hired _________________________________________                    Applicant Rejected _____________________________________________

Date Employed _________________________________________                     Point Employed _______________________________________________

Department ____________________________________________                    Classification _________________________________________________

(If Rejected, summary report of reasons should be placed in file)

THIS SECTION TO BE FILLED IN BY RESPONSIBLE OFFICER OR COMPANY REPRESENTATIVE

  SUPERIOR GOOD FAIR BELOW AVERAGE POOR WRITTEN RECORD ON FILE
1.Application            
2. Interview            
3. Past Employment            
4. Written Exam            
5. Road Test            
6. Criminal/Traffic      Convictions            

Signature of Interviewing Officer _____________________________________________________________

===========================================================================================================================

TRANSFERS

From: ______________________     To: __________________________

Date: ______________________

Reason For Transfer ___________________________________________

 

From: ______________________     To: __________________________

Date: ______________________

Reason For Transfer ___________________________________________

 

 

From: ______________________     To: __________________________

Date: ______________________

Reason For Transfer ___________________________________________

 

 

From: ______________________     To: __________________________

Date: ______________________

Reason For Transfer ___________________________________________

 

___________________________________________________________________________________________________________________________

TERMINATION OF EMPLOYMENT

Date Terminated ___________________________________________                    Department Released Form ____________________________________

Dismissed _______________________________                    Voluntarily Quit ________________________            Other ___________________________

Termination Report Placed On File ______________________________                    Supervisor ________________________________________________


REQUEST & CONSENT FOR PREVIOUS EMPLOYER DRUG & ALCOHOL TESTS

I _________________________________________________________________________________, hereby authorize

                                (Applicant name)                                            (Social Security Number)

that _________________________________________________Phone:______________________________________

                                (Previous Employer)

City, State, Zip ________________________________________

May release and forward information requested by section 2 of this document concerning my alcohol and drug testing records to:

Jon Mar Trucking Company

P.O. Box 3205

South Amboy, N.J. 08879

(732) 727-7001 - phone        (732) 727-7031 - facsimile

In compliance with the federal law (40.25(g)) the release of this information must be made in written form that will ensure confidentially, such as fax, email, or written letter.

Applicant signature ____________________________________        Date____________________________________

=======================================================================================

Section 2 - Previous Employer

                                                                                                                                                YES                            NO

1.) Has the above named ever have an alcohol test with result of 0.04 or higher?            ______                      ______

2.) Has this person had a verified positive drug test?                                                         ______                      ______

3.) Has this person refused to be tested or have a sample retested?                                 ______                      ______

4.) Has this person committed other violations of DOT agency drug and alcohol

     testing regulations?                                                                                                          ______                     ______

5.) If this person has violated a DOT drug and alcohol regulation, do you have

     documentation of the employees successful completion of DOT return to duty

     requirements, including follow up testing?                                                                      ______                      ______

(Please send this information, if applicable)

Company Name ______________________________________________       Contact ___________________________

Address __________________________________________________________________________________________

Signature ___________________________________________________        Date _____________________________

=======================================================================================

Section 3 - Perspective Employer

This form was sent via  ______________________________________________ on ________________ Response was

                                                            (mod of transmission)                                                     (date)

received via ________________________________________on __________________ by _______________________.

                                    (mode of transmission)                                            (date)                            (employers name)

 


REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER

 

To _____________________________________________________________________________    Date ____________________________________

From: Jon Mar Trucking Company, P.O. Box 3205, South Amboy, N.J. 08879

                        Recently a former employee of your company made application to work at Jon Mar as a tractor trailer driver/owner operator.  In               accordance with DOT regulations we are requesting that you complete the following information and return this form via fax to (732) 727-7031, any problems please call (732) 727-7002.

                        On the applications Mr./Ms. ____________________________________________________ states that he/she was employed

                        from __________________________ to _____________________________.

==============================================================================================================

   YES NO
1.) Are the dates of employment correct as stated above? ______ ______
2.) Was he/she handling valuables?  ______ ______
3.) Were his/hers accounts properly kept?  ______ ______
4.) Did he/she drive a flatbed tractor trailer for your company?  ______ ______
5.) Was he/she a safe and efficient driver? ______ ______
6.) Did he/she have any accidents?     ______ ______
7.) Did he/she receive any Workers Compensation at any time? ______ ______
8.) Was his/hers conduct satisfactory?    ______ ______
9.) Would you rehire this applicant  ______ ______
10.) Reason for leaving your company ______ ______

==============================================================================================================

                                                                                                           Excellent                Good                Fair                Poor

Quality of Work                                                                                ________            ________           ________       ________

Cooperation                                                                                      ________            ________           ________       ________

Safety Habits                                                                                     ________            ________           ________       ________

Personal Habits                                                                                ________            ________            ________       ________

Driving Skills                                                                                    ________            ________            ________        ________

 

Any other comments _________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

 

Date ________________________________________                                                            For _____________________________________________

                                                                                                                                                                                        (Name of Company)

Supervisor ___________________________________                                                            By ______________________________________________

                             (Print Supervisor Name)                                                                                                                (Signature of Supervisor)