Driver's Application for Employment
Date of Application: December 3, 2022
Company: Schiffman Trucking, Inc.
Address: PO Box 260167, Plano, TX 75026
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.
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 my employment, I understand that false or misleading information given in my application of interview(s) may result in discharge. I understand, also, that I am require to abide by all rules and regulations of the Company.
I understand that information I provide regarding current and/or previous employers may be used, and those employers(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
TERMINATION OF EMPLOYMENT
Department Released From:
Termination Report Placed In File:
Position(s) Applied for:
Social Security No:
List your addresses of residency for the past 3 years:
State & Zip Code:
Do you have the legal right to work in the United States? YesNo
Date of Birth:
Can you provide proof of age?YesNo
Have you worked for this company before?YesNo
If yes, where?
Rate of Pay:
Reason(s) for Leaving:
Are you now employed?YesNo
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected:
Have you ever been bonded? YesNo
If Yes, Name of bonding company:
Have you ever been convicted to a felony?YesNo
If yes, explain if you wish.
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 or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
Salary / Wage:
Reason for Leaving:
Were you subject to the FMCSRs while employed?YesNo
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?YesNo
Were you subject to the FMCSRs while employed? YesNo
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? YesNo
*Includes vehicles having a GVWR of 26,001 lbs. 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.
* The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in intestate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR or 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.
For Past 3 years or more (ATTACH SHEET IF MORE SPACE IS NEEDED). If none, write none.
And forfeitures for the past 3 years (OTHER THAN PARKING VIOLATIONS). If none, write none.
List all driver licenses or permits held in the past 3 years
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license, permit or privilege ever been suspended or revoked?
If the answer to both A and B is "Yes", please give details:
Check Yes or No.
CLASS OF EQUIPMENT
CHECK TYPE OF EQUIPMENT
APPROX. NO. OF MILES(total)
Tractor & Semi Trailer
More than 8 passengers
More than 15 passengers
List States Operated in for the last five years:
Show Special Courses or Training that will help you as a driver:
Show any trucking, transportation, or other experience that may help in your work for this company:
List courses and other training other than shown elsewhere in this application:
List special equipment or technical materials you can work with (Other than those already shown)
Check Highest Grade Completed: 12345678
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.
Company Name: Schiffman Trucking, Inc.
Date: December 3, 2022
Social Security Number:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Driver's Application for Employment
Agree & Sign