Driver's Application For Employment


Applicant Name:

Date of Application:

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 previuos 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 – please print)

Position(s) Applied for 


Name

Last:

First:

Middle:

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?

Where?

Dates: From

to

Rate of Pay

Position

Reason 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? 

Name of bonding company 

Have you ever been convicted to a felony?

If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

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 empployers 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 YOU 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 YOU 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 YOU 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

CITY

STATE

ZIP

SALARY/WAGE

CONTACT PERSON

PHONE NUMBER

REASON FOR LEAVING

WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

WAS YOU 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 YOU 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 YOU 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 AND 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 EITHER A OR B IS YES, GIVE DETAILS

 

DRIVING EXPERIENCE

CHECK YES OR NO

CLASS OF EQUIPMENT

CHECK TYPE OF EQUIPMENT

DATES

FROMTO

APPROX. NO. OF MILES
(total)

STRAIGHT TRUCK 

TRACTOR AND SEMI-TRAILER

TRACTOR-TWO TRAILERS

TRACTOR-THREE TRAILERS

MOTORCOACH – SCHOOL BUS

More than 8 passengers

MOTORCOACH – SCHOOL BUS

More than 15 passengers

 

LIST STATES OPERATED IN FOR LAST FIVE YEARS: 

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER: 

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM? 


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 METERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)


EDUCATION

CHECK HIGHEST GRADE COMPLETED

HIGH SCHOOL :

COLLEGE: 

LAST SCHOOL ATTENDED 


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 

DATE:

SOCIAL SECURITY NUMBER:

Leave this empty:

Signature Certificate
Document name: Driver's Application For Employment
Unique Document ID: 33e5be752a9b3e5568e6ce3f4987ea783d4a1061
TimestampAudit
2016-11-14 20:07:44 CSTDriver's Application For Employment Uploaded by Lynn Moore Schiffman - rj.rijo8@gmail.com IP 122.54.156.240