Driver Application

DRIVER APPLICATION

__ 4820 SW 20th St Oklahoma City, Ok 73128

__ 2681 N. Florence Ave Tulsa, OK 74110

__ 426 Metro Park Dr McKinney, TX 75071

Applying for Full __ or Part Time______

PLEASE CHECK LOCATION WHERE APPLIED. YOU MUST FILL OUT THIS ENTIRE FORM COMPLETELY OR IT WILL BE CONSIDERED AN INCOMPLETE APPLICATION.

Name ______

(Last) (First) (M.I.)

Present Address ______How long? ______

(Street) (City, State & Zip)

Previous Address ______How long? ______

(Street) (City, State & Zip)

Date of Birth ______Social Security No. ______

Phone No. ______Cell Phone No. ______

Email Address ______

Experience and Qualifications

List all state- issued licenses held the past three years.
State / License No. / Type / Exp. Date
Drivers Licenses

Driving Experience (Must be included in your employment history)

Class of Equipment / Type of Equipment (Van, Tank, Flat, Etc.) / From / To / Approx. No. of Miles (Total)
Bus
Tractor and Semi-Trailer
Tractor -Two Trailer
Other

Accident Record for the past 3 Years or More (Attach Sheet if more space is needed)

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)

Location / Date / Charge / Type of Vehicle Operated

(Attach sheet if more space is needed)

A.  Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes __ No __

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

Yes __ No__

C.  At times drivers are required to lift luggage in excess of 25-50 lbs, is there anything that restricts you from doing so?

Yes__ No__

D.  Drivers are required to do over the road or multi day trips. Is there anything that prevents you from doing so?

Yes__ No__

E. Have you been convicted of a felony?

Yes __No__

If the answer is yes, attach statement giving details

Employment Record

(Attach a sheet if more space is needed)

Note: DOT requires that employment for the previous 3 years be provided. In addition to your previous 3 years of all employment history, DOT requires you to list additional commercial driving experience for the past 10 years.

IF YOU HAVE A GAP IN YOUR EMPLOYMENT HISTORY PLEASE LIST THE REASONS IN BETWEEN EACH JOB WHERE THE GAP OCCURRED.

DATES MUST INCLUDE MONTH/YEAR

Last Employer Name
Address
Phone # & Fax
Position Held / From To Salary
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations while employed at this job? Y N
Was your position designated as a safety-sensitive position and subject to DOT Alcohol and Controlled
Substance Testing? Y N

GAP ______

Second Last Employer Name
Address
Phone # & Fax
Position Held / From To Salary
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations while employed at this job? Y N
Was your position designated as a safety-sensitive position and subject to DOT Alcohol and Controlled
Substance Testing? Y N

GAP ______

Third Employer Name
Address
Phone & Fax
Position Held / From To Salary
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations while employed at this job? Y N
Was your position designated as a safety-sensitive position and subject to DOT Alcohol and Controlled
Substance Testing? Y N

If you have additional employment history, please use a separate sheet of paper.

HOW DID YOU HEAR ABOUT THIS POSITION? ______

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 understand that information provided on previous employment and my safety performance history, as indicated in 49 CFR 391.23, will be investigated with previous employers

Date ______Applicant’s Signature ______

Note: A motor carries may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.

Applications Reviewed by: ______

Revised 06/19/14