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APPLICATION FOR EMPLOYMENT

Requesting Employer:

Truck's, Inc.

This transportation company is an equal opportunity employer in compliance with all Federal and State equal employment opportunity laws. Consideration of qualified applicants for any position is made without regard to the applicant's sex, race, color, national origin, marital status, age, religion, or non-job-related disability.

Position(s) applied for: Driver

Name:

Email:

Date of Birth:

Address:

Phone: Social Security Number:

Previous Address:

How long at this address?

Previous Address:

How long at this address?

Can you be legally employed in the United States? (Required for commercial drivers)

Do you have proof of age?

Have you ever been employed by this company before?

If so, When?

What was your rate of pay?

Position held?

What was your reason for leaving?

Are you working now?

If not, how long since you were last employed?

What rate of pay are you expecting?

How did you here about this company?

May we contact your present employer?

After reviewing the job description, for what reasons might you be unable to perform the duties of the position for which you are applying? You may explain.

Who referred you to us?

In Accordance with the FMCSR Section 383.35: The following employment history information for the 10 years preceding the date the application is submitted shall be presented to the prospective employer by the applicant

(1) A list of the names and addresses of the applicant's previous employers for which the applicant was an operator of a commercial motor vehicle; (2) The dates the applicant was employed by these employers; and

(3) The reason for leaving such employment. The applicant shall certify that all information furnished is true and complete. Notice: The information provided may be used and previous employers my be contacted for the purpose of investigating the applicant's work history.

__________________________________________________________________

EMPLOYER: PHONE:
CONTACT: Employed From: To:
Address:
Position: Salary:
Reason for leaving:

__________________________________________________________________

EMPLOYER: PHONE:
CONTACT: Employed From: To:
Address:
Position: Salary:
Reason for leaving:

__________________________________________________________________

EMPLOYER: PHONE:
CONTACT: Employed From: To:
Address:
Position: Salary:
Reason for leaving:

__________________________________________________________________

EMPLOYER: PHONE:
CONTACT: Employed From: To:
Address:
Position: Salary:
Reason for leaving:

__________________________________________________________________________________

Driving Qualifications and Experience

License Information:

State: License No. Endorsements: Expiration Date:

__________________________________________________________________

Equipment Experience

Equipment Class

Equipment Type:

Tractor & Semi-Trailer

Total Miles (appx.)

Tractor w/ Two Trailers

Total Miles (appx.)

Straight Truck

Total Miles (appx.)

Other

Total Miles (appx.)

In what States have you operated - past 3 years?

Have you ever had your license revoked or suspended?

If so, when and where?

Why? (please explain)

ACCIDENTS PAST 7 YEARS (list most recent first)

Date: Injuries? Fatalities? Describe:
Date: Injuries? Fatalities? Describe:
Date: Injuries? Fatalities? Describe: Date: Injuries? Fatalities? Describe:

TRAFFIC CONVICTIONS PAST 7 YEARS (not parking violations)

Date: Where? Violation? Penalty:
Date: Where? Violation? Penalty:
Date: Where? Violation? Penalty:

Use space below to comment's on accidents & violations

Education and Training

What was the highest grade you completed?

Where?

What special training have you received that will benefit you in this job?

Use this space to list any experience or knowledge you have, not covered previously, or to make any comments you wish:

READ THE FOLLOWING CAREFULLY AND SIGN BELOW

By signing this statement I certify that this employment application has been completed by me, and all of the entries provided are true, complete and accurate to the best of my knowledge. By signing below I also authorize this company to make such inquiries into my employment, financial, personal, or medical history as might be needed to make an employment decision. I understand that inquiries into my medical history are generally made after a job offer is made.

I hereby release my former employers, healthcare providers and schools from any and all liability in making response to these inquiries and from releasing the requested information.

I understand that as an employee of Truck's, Inc., I will be performing my job duties for Trucks, Inc. and will adhere to all rules, regulations and guidelines as set forth by Trucks, Inc.

Initial here :

Request for Information from Previous Employment

I hereby authorize you to release any information regarding my services, character and conduct while in your employment, to Trucks, Inc. for purposes of investigation as required by Section 391 and 382 of the FMCSR. You are released from any liability which may result from furnishing such information.

In order to enable Trucks, Inc. to comply with the regulations of the FMCSR, I hereby consent to Trucks, Inc. obtaining from my prior employers the information pertaining to any positive controlled substance test results, alcohol tests with a concentration result of 0.04 or higher and refusals to be tested within the preceding three (3) years of the date of this application.

I understand that I, as the applicant, have the right to review the information obtained. I also understand that I must make that request in writing to Trucks, Inc. and they will have 5 days in which to respond.

Applicant’s Name: SS#

Initial here:

_____________________________________________________________

To Former Employer Only: Please complete the following and return to fax 770-775-4990 or email at safety@trucksinc.net at your earliest convenience. Thank you for your cooperation.

Name of Company: ____________________________

US DOT #: __________________

Period(s) of Employment: from _______ to _______ and from ________ to ________

Driver: 🮮 yes no Part time Full time 🮮 Company Driver Owner-Operator Driver for O/O

Equipment: 🮮 Tractor Trailer Van Reefer Tank Flatbed Other ________

List states in which applicant drove regularly: _________________________________

Commodities Hauled: ___________________ Number of Trucks You Operate:_______

Accidents: ______Number DOT Reportable _____Number Non-DOT Reportable______

Dates, Description and $ Amount : ________________________________________________

Tickets: 🮮 Yes No If yes, describe: ______________________________________________

License Suspension: 🮮 Yes No If yes, describe: ___________________________________

Why did Applicant leave your employ? Is Applicant eligible for rehire? 🮮 Yes No If no,

why? __________________________________________________________________

__________________________________________________________________

Has this person ever tested positive for a controlled substance in the past 3 years?

🮮 Yes No

Has this person ever had an alcohol test with a Breath Alcohol Concentration of

0.04 or greater in the last 3 years?

🮮 Yes No

Has this person ever refused a required test for drugs or alcohol in the past 3 years?

🮮 Yes No

Has this person violated any FMCSA Drug or Alcohol regulation in the past 3 years?

🮮 Yes No

Have you received information from a previous employer that this individual violated

DOT Drug and Alcohol regulations in the past 3 years?

🮮 Yes No

Please Mark the Appropriate Rating:

Quality of Work 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Safety Habits 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Driving Skill 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Log Accuracy 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Punctuality 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Dependability 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Grooming 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Cooperation 🮮 Very Good 🮮 Good 🮮 Fair 🮮Poor

Person providing information:

Date: _________________

Signature:_________________________________

Print Name: ________________________________

___________________________________________________________

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

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December 28, 2021 1:58 pm EDT

Apply Now Uploaded by Trucks Inc - safety@trucksinc.net IP 12.222.95.242