Driver Application
Name: ______Phone: ______
(First)(Middle)(Last)
Address: ______How Long? ______
(Street)(City)(State & Zip)
Date of Birth: ______Social Security Number: ______
Please list any previous address (es) for the past 3 years if different from current.
Address: ______How Long? ______
(Street)(City)(State & Zip)
Address: ______How Long? ______
(Street)(City)(State & Zip)
EXPREIENCE & QUALIFICATIONS
Drivers Licenses
State / License Number / Type / Expiration DateDRIVING EXPERIENCE
Class of Equipment / Type of Equipment (Van, Tank, Flat, etc.) / Dates From / Dates To / Approx. No. of MilesAccident Record for Past 3 Years or More (If more space is needed write on back)
Dates / Nature of Accident / Fatalities / InjuriesLast Accident
Next Previous
Next Previous
Next Previous
Next Previous
Next Previous
Traffic Convictions and Forfeitures for the Past 3 Years
(Other than parking)
Location / Charge / Date / PenaltyA. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Y / N
B. Has any licenses, permit or privilege ever been suspended or revoked? Y / N.
(If the answer to any of the above is yes please explain)
______
Employment Record
(Use back if more space is needed)
Note: DOT requires that each applicant give at least 10 years employment or commercial driving experience!!
Last Employer: ______Contact: ______
Address: ______Position Held: ______
From: ______to: ______Salary: ______
Third Employer: ______Contact: ______
Address: ______Position Held: ______
From: ______to: ______Salary: ______
Forth Employer: ______Contact: ______
Address: ______Position Held: ______
From: ______to: ______Salary: ______
Fifth Employer: ______Contact: ______
Address: ______Position Held: ______
From: ______to: ______Salary: ______
NO APPLICATION WILL BE PROCESSED WITHOUT AT LEAST 10 YEARS FILLED IN
TO BE READ AND SIGNED BY APPLICANT
This certifies that the application was completed by me, and that all information is true and complete to the best of my knowledge.
Date: ______Applicant Signature: ______
IMPORTANT NOTICE
REGARDING BACKGROUND REEPORTS
FROM THE PSP ONLINE SERVICES
In connection with your application for employment with Koon Trucking, LLC, it may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decisions regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Perspective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
I authorize Koon Trucking LLC, to access the FMCSA Pre-employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to If I am challenging crash or inspection information reported by a state, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.
I have read the previous Notice Regarding Background Reports provided to me by Koon Trucking, LLC and I understand that is I sign this consent form, by Koon Trucking LLC may obtain a report of my crash and inspection history. I hereby authorize by Koon Trucking LLC and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Date: ______Signature: ______Print: ______
RELEASE OF INFORMATION
I, ______, give my permission to Koon Trucking LLC, to investigate and make inquiries of my personal, employment, medical previous drug and alcohol testing, and my driving record, for the sole purpose of arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from any and all liability in responding to inquiries and releasing information in connection with my application.
______
Applicant SignatureDate
______
Applicant Social Security Number
DRUG & ALCOHOL POLICY
DRUG AND ALCOHOL FREE WORK PLACE
FOR THE SAFETY OF YOU AS A DRIVER, OTHERS AROUND YOU, THE CUSTOMER, THE EQUIPMENT, THE CARGO, AND THE COMPANY, SUBSTANCE ABUSE CANNOT AND WILL NOT BE TOLERATED IN ANY FORM. DRUGS OR ALCOHOL ARE NOT TO BE IN YOUR TRUCK OR ON THE PREMISES OF KOON TRUCKING LLC. TERMINAL OR ANY CUSTOMER SITE FOR ANY REASON AT ANY TIME. VIOLATION WILL BE IMMEDIATE TERMINATION. WE REQUIRE THAT YOU BE COMPLETE FREE OF ANY DRUG OR ALCOHOL PRIOR TO ENTERING YOUR TRACTOR, PRIOR TO COMING TO THE YARD OR ANY CUSTOMER SITE TO ACCEPT YOUR DISPATCH, AND PRIOR TO PERFORMING ANY FUNCTION FOR THE COMPANY.
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Driver SignatureDate
______
Company RepresentativeDate
LOG BOOK POLICY
DRIVER LOGS
A. HOW TO COMPLETE
1. All drivers are required to legally complete the daily log in accordance with the appropriate regulations given in the FMCSA regulations. If you are part of a team or slip seat operation, the logs must reflect consistent, accurate entries. NO EXCEPTIONS!!
2. Please make sure your logs are neat and legible.
3. Please log all overweight citations, road fuel purchases, speeding citations, accidents, DOT inspections or any other inspections or citation by any agency or courtesy check.
4. Please reflect your pre-trip inspections on your logs each time you change equipment. Log your in-route and post-trip
B. WHEN AND WHERE TO TURN IN LOGS
1. Logs are to be turned in weekly in your trip envelope
2. A driver whose logs are more than 1 week behind will be placed on non-driving status until all logs are brought current.
C. CONSEQUENCES OF REPETIVE LOG VIOLOATIONS
A log violation letter will be sent listing incidents that violate the FMCSR. CHRONIC LOG VIOLATIONS CANNOT BE TOLERATED.
1. Logs must be filled out in their entirety!!! (To and from destination, Bol/Commodity, miles, etc.)
2. Excessive log violations will result in proof of taking a log class.
3. If, after taking this class you continue to have violations of excessive nature you will be placed on a 1 week suspension without pay.
4. If the violations continue you will be terminated…NO QUESTIONS ASKED…
Driver Signature: ______Date: ______
Company Representative: ______Date: ______
Receipt
I hereby acknowledge receipt of a copy of the Koon Trucking LLC Drug and Alcohol Policy, Logbook Policy and Handbook. I agree to familiarize myself with the policies and to comply with all company policies and regulation / requirements, at all times while on duty as a driver.
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Driver SignatureDate
______
Company RepresentativeDate
***Changes or amendments to the driver’s handbook may be approved at any time***
Hours of Service Record for First Time or Intermittent Drivers
Instructions: When using a driver for the first time or intermittently, a signed statement must be obtained, giving the total time on duty (driving and on duty) during the immediate preceding seven days and the time at which the driver was last relieved from duty prior to beginning work.
Name (Print) ______
FirstMiddleLast
Day / Total Time on Duty1
2
3
4
5
6
7
Total Hours Driven
I hereby certify that the information contained herein is true to the best of my knowledge and belief, and that my last period of release from duty was from the following:
______To ______
(Hour / Date)(Hour / Date)
Signature: ______Date: ______
U.S. DEPARTMENT OF TRANSPORTATION MOTOR CARRIER SAFETY PROGRAM ANNUAL REVIEW OF DRIVING RECORD 391.25
______
Name: Last, First, M.ISocial Security Number
This day I reviewed the driver record of the above named driver in accordance with 391.25 of the Federal Motor Carrier Safety Regulations. I considered and evidence that the driver has violated applicable provisions of the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations. I considered the driver’s accident record and any evidence that he/she violated laws governing the operation of motor vehicles, and gave great weight to violation, such as speeding, reckless driving and operation while under the influence of alcohol or drugs, that indicate that the driver has exhibited a disregard for the safety of the public. Having done the above, find that:
[ ] the driver meets the minimum requirements for safe driving, or
[ ] the driver is disqualified to drive a motor vehicle pursuant to 391.15
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Date of ReviewMotor Carrier’s Name
______
Reviewed By: Signature and title
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Date of ReviewMotor Carrier’s Name
______
Reviewed By: Signature and title
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Date of ReviewMotor Carrier’s Name
______
Reviewed By: Signature and title
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