Application for Driving Employment Form

Position applied for*

Referred by

First Name*

Last Name*

Preferred Name

Preferred Pronouns

Phone*

Email*

Are you currently vaccinated against COVID-19?*YesNo

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.

Present Address*

City*

State*

Zip*

How long have you lived there?

Education History
Select 'Add Row' to add another entry.

Education

Name and location of school

Subjects studied

Did you graduate?

Year of graduation

Education

Name and location of school

Subjects studied

Did you graduate?

Year of graduation

Education

Name and location of school

Subjects studied

Did you graduate?

Year of graduation

Employment History

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven commercial motor vehicles for the seven years prior to the initial three years (total of ten years employment record). Commercial motor vehicles include: vehicles having a GVWR of 26,001 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.

Employer

From*

To*

Employer Name*

Employer Phone*

Position Held*

Reason for leaving*

Were you subject to the FMCSRs* while employed?*

Was your job designated as a safety-sensitive function in and DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?*

Employer

From*

To*

Employer Name*

Employer Phone*

Position Held*

Reason for leaving*

Were you subject to the FMCSRs* while employed?*

Was your job designated as a safety-sensitive function in and DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?*

*The 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) weights 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.

Date you can start*

Salary desired*

Are you employed now?*YesNo

If so, may we inquire of your present employer?*YesNo

Have you ever applied to this company before?*YesNo

If so, when?

Do you have the legal right to work in the US?*YesNo

Date of birth (required for commercial drivers ONLY)

Can you provide proof of age?*YesNo

Have you ever worked for this company before?*YesNo

Position

From

Reason for leaving

Is there any reason you might be unable to perform the functions of the job for which you have applied?*YesNo

If yes, please explain

License Information

Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Drivers licenses or permits held in the past 3 years.

State

License Number

Class

Expiration Date

State

License Number

Class

Expiration Date

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

Has any license, permit, or privilege to operate a motor vehicle ever been suspended or revoked?*YesNo

If the answer to either of the questions above is yes, please explain.

Accident record for past three years or more. Select 'Add Row' to add another incident.

Date

Nature of accident (head on, rear end, upset, etc.)

Fatalities

Injuries

Date

Nature of accident (head on, rear end, upset, etc.)

Fatalities

Injuries

Traffic convictions and forfeitures for the past three years or more (other than parking violations).

Location

Date

Violation

State Violation Occured

Penalty

Location

Date

Violation

State Violation Occured

Penalty

Driving Experience

Class of equipment

Type of equipment (van, tank, flat, dump, refer)

Dates (MM/YYYY)

Approx. # of miles driven

Class of equipment

Type of equipment (van, tank, flat, dump, refer)

From (MM/YYYY)

To (MM/YYYY)

Approx. # of miles driven

List states operated in for last five years:*

List special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

List any special equipment you can operate or have worked with in the past:

References
Please list the name of two persons not related to you whom you have known at least one year.
When possible, at least one person should be a professional reference, preferably a recent or current supervisor or manager.

Name

Address/Phone

Business

Years Acquainted

Name*

Address/Phone*

Business*

Years Acquainted*

Name*

Address/Phone*

Business*

Years Acquainted*

TERMS OF ACCEPTANCE and SIGNATURE

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 employment history and other related matters as may be necessary in arriving at an employment decision.

I hereby release employers, schools 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 and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

I further understand, that I am required to abide by all rules and regulations of Veritable Vegetable.

Electronic Signature*

Please type your First and Last Name