Driver's Application For Employment
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:
FOR COMPANY USE
TERMINATION OF EMPLOYMENT
DEPARTMENT RELEASED FROM:
TERMINATION REPORT PLACED IN FILE:
APPLICANT TO COMPLETE (answer all questions – please print)
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?
Have you worked for this company before? YesNo
Rate of Pay
Reason 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?
Name of bonding company
Have you ever been convicted to a felony? YesNo
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.
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.)
REASON FOR LEAVING
WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? YesNo
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? 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.
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED)IF NONE, WRITE NONE
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE
EXPERIENCE AND QUALIFICATIONS – DRIVER 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? YesNo
B. Has any license, permit or privilege ever been suspended or revoked? YesNo
IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS
CHECK YES OR NO
CLASS OF EQUIPMENT
CHECK TYPE OF EQUIPMENT
APPROX. NO. OF MILES (total)
STRAIGHT TRUCK YesNo
TRACTOR AND SEMI-TRAILER YesNo
TRACTOR-TWO TRAILERS YesNo
TRACTOR-THREE TRAILERS YesNo
MOTORCOACH – SCHOOL BUS YesNo
More than 8 passengers
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)
CHECK HIGHEST GRADE COMPLETED 12345678
HIGH SCHOOL : 1234
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.
SOCIAL SECURITY NUMBER:
Leave this empty:
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