Driver's Application for Employment


Applicant Name:

Date of Application:
August 15, 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.


TO BE READ AND SIGNED BY APPLICANT

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:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employers(s) and I cannot agree on the accuracy of the Information.

FOR COMPANY USE

PROCESS RECORD

Applicant Hired:

Rejected:

Date Employed:

Point Employed:

Department:

Classification:

TERMINATION OF EMPLOYMENT

Date Terminated:

Department Released From:

Termination Report Placed In File:

Supervisor:


APPLICANT TO COMPLETE
(answer all questions)

Position(s) Applied for:
 

Last Name: 
 

First Name:
 

Middle Name:

Social Security No:

List your addresses of residency for the past 3 years:

Current Address

Street:

City:

State:

Zip Code:

Phone:

How Long?

Previous Addresses

Street:

City:

State & Zip Code:

How Long?

Street:

City:

State & Zip Code:

How Long?

Street:

City:

State & Zip Code:

How Long?

Do you have the legal right to work in the United States?

Date of Birth:

Can you provide proof of age?

Have you worked for this company before?

If yes, where?

Dates From:

To:

Rate of Pay:

Position:

Reason(s) for Leaving:

Are you now employed?

If not, how long since leaving last employment?

Who referred you? 

Rate of pay expected: 

Have you ever been bonded? 

If Yes, Name of bonding company:

Have you ever been convicted to a felony?

If yes, explain if you wish.


EMPLOYMENT HISTORY

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.)

EMPLOYERDATE

Name:

From:

To:

Address:

Position Held:

City:

State:

Zip:

Salary / Wage:

Contact Person

Phone Number:

Reason for Leaving:

Were you subject to the FMCSRs 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?

EMPLOYERDATE

Name:

From:

To:

Address:

Position Held:

City:

State:

Zip:

Salary / Wage:

Contact Person

Phone Number:

Reason for Leaving:

Were you subject to the FMCSRs 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?

EMPLOYERDATE

NAME:

From:

To:

Address:

Position Held:

City:

State:

Zip:

Salary / Wage:

Contact Person:

Phone Number:

Reason for Leaving:

Were you subject to the FMCSRs 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?

*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.


ACCIDENT RECORD

For Past 3 years or more (ATTACH SHEET IF MORE SPACE IS NEEDED). If none, write none.

 DATESNATURE OF ACCIDENT
(HEAD-ON, REAR-END,UPSET, ETC.)
FATALITIESINJURIESHAZARDOUS MATERIAL SPILL

LAST ACCIDENT

NEXT PREVIOUS

NEXT PREVIOUS


TRAFFIC CONVICTIONS

And forfeitures for the past 3 years (OTHER THAN PARKING VIOLATIONS). If none, write none.

LOCATIONDATECHARGEPENALTY


EXPERIENCE & QUALIFICATIONS - DRIVER

List all driver licenses or permits held in the past 3 years

DRIVER LINCENSESSTATELICENSE NO.EXPIRATION DATE

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:


DRIVING EXPERIENCE

Check Yes or No.

CLASS OF EQUIPMENT

CHECK TYPE OF EQUIPMENT

DATES

APPROX. NO. OF MILES
(total)

Straight Truck

From:

To:

Tractor & Semi Trailer

From:

To:

Tractor-Two Trailers

From:

To:

Tractor-Three Trailers

From:

Motorcoach-School Bus

More than 8 passengers

 

From:

To:

Motorcoach-School Bus

More than 15 passengers

 

From:

List States Operated in for the last five years:

Show Special Courses or Training that will help you as a driver:


EXPERIENCE AND QUALIFICATIONS - OTHER

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)


EDUCATION

Check Highest Grade Completed:

High School:

College:


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.

Company Name: Schiffman Trucking, Inc.

Date: August 15, 2022

Social Security Number:

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Driver's Application for Employment
lock iconUnique Document ID: 7b2a72a846432e571d23bdd61fed9112fa446b96
TimestampAudit
January 28, 2022 6:39 am CDTDriver's Application for Employment Uploaded by Lynn Moore Schiffman - lynn@schiffmantrucking.com IP 49.150.208.88