Driver Application

Applicant Info

First name

Middle name

Last name

Street Address

City

State

Zip

Phone Number

Best Time To Call

Positions Applied For

Date of Application

How did you learn about us?

Have you ever filed an application with us before? (If so, include date)

Have you ever been employed with us before? (If so, include date)

Are you currently employed?

May we contact your present employer?

Are you currently on layoff status and subject to recall?

Are you available to work (check all that apply):

Full Time

Part Time

Shift Work

Temporary

On what date would you be available for work?

Days and hours available to work:

Can you travel if a job requires it?

If under 18 years of age, can you provide required proof of your eligibility to work?

In compliance with federal law, will you be able to provide proof of identity and eligibility to work in the United States if you are hired?

Education

Please include Name and Address of School, Course of Study, Number of Years Completed, and Diploma/Degree

High School Education

Undergraduate College

Graduate Professional

Other (Please Specify)

Please list any scholarships, academic honors or special achievements:

List professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Describe any specialized training, job-related training received in the United States military, apprenticeship, skills, extra-curricular activities, and foreign languages.

State any additional information you feel may be helpful in considering your application.

List the names and telephone numbers of three work or school references who are not related to you. Also include a description of their relationship to you and the number of years you have known them.

Driver Information

The Federal Motor Carrier Safety Regulations require that driver applicants state their date of birth and social security number.

Date of Birth

Social Security Number

The Federal Motor Carrier Safety Regulations require that driver applicants answer the following questions.

Within the last 3 years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer with which you applied for, but did not obtain, safety-sensitive transportation work?

Within the last 3 years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you performed safety-sensitive transportation work?

If you answered yes to either of the questions above, can you provide and/or can you obtain proof that you have successfully completed the DOT return-to-duty requirements?

The Federal Motor Carrier Safety Regulations require that driver applicants provide the addresses at which they have resided during the last 3 years preceding the date on which the application is submitted. Please include the address and Date range resided at the address.

Driver's License Information

Driver’s licenses held in the past 3 years and each unexpired commercial motor vehicle operator’s license or permit that has been issued to the applicant must be listed.

State

License Number

Type

Expiration Date

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

Have you ever had any license, permit, or privilege to operate a motor vehicle suspended or revoked?

Have you ever been disqualified for violations of the Federal motor Carrier Safety Regulates?

If you answered “YES” to any of the questions above, please attach a statement giving details.

Driving Experience

For the classes of equipment listed, include Type of Equipment used, Dates (From/To), and Approximate Total Miles.

Straight Truck

Tractor and Semi-Trailer

Twin

Other

List states operated in during the last 5 years

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

List safe driving awards held and by whom they were presented

ACCIDENT HISTORY

Accident review for the past 3 years. Include the Date, Nature of Accident, Number of Fatalities, Number of Injuries, Number of Vehicles Towed, and if any Citations were issued.

MOTOR VEHICLE DRIVING RECORD (MVR)

Traffic convictions and forfeitures for the past 3 years, other than parking violations. For each, include the Date, Location, Charge, and Penalty.

Employment Experience

Begin with your most recent employment and continue with all past employment. Attach additional sheets if necessary.

Employer:

Address:

Phone Number(s):

Job Title:

Supervisor:

Reason for Leaving:

Work Performed:

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

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

Explain any gaps in your employment, other than those due to personal illness, injury or disability.

3840 Millstone Parkway

St. Charles, MO 63301

(314) 436-5010