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BOOK YOUR MOVE TODAY | 605-342-1460
417 Pine St, Rapid City, SD 57701
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Drivers Application For Employment
Drivers
Application For Employment
Step
1
of
17
5%
Date of Application
*
MM slash DD slash YYYY
Position(s) Applied For
*
Referral Source:
*
Advertisement
Friend
Relative
Walk-In
Employment Agency
Other
Name
*
First
Last
Phone
*
Alternate Contact Phone
Email
Current Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Previous Address 1
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Previous Address 2
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Previous Address 3
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have the legal right to work in the United States?
*
Yes
No
Date of Birth
*
MM slash DD slash YYYY
Can you provide proof of age?
*
Yes
No
(Required for Commercial Drivers)
Have you filed an application here before?
*
Yes
No
If Yes, give date
Have you ever been employed here before?
*
Yes
No
If Yes, give date
Reason for leaving
Are you employed now?
*
Yes
No
May we contact your present employer?
*
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
*
Yes
No
(Proof of citizenship or immigration status may be required upon employment)
On what date would you be available for work?
*
MM slash DD slash YYYY
Are you available to work
*
Full Time
Part Time
Shift Work
Temporary
Are you on a lay off and subject to recall?
*
Yes
No
Can you travel if a job requires it?
*
Yes
No
Have you been convicted of a felony within the last 7 years?
*
Yes
No
If Yes, please explain
Have you ever been bonded?
*
Yes
No
Name of bonding company
Can you perform, with or without reasonable accomodation, the essential functions of the job [as described in the attached job description]?
*
Yes
No
Who referred you?
First
Last
Check one:
*
Male
Female
Check one of the following Race/Ethnic Group:
*
White
Black
Hispanic
American Indian/Alaskan Native
Asian/Pacific Islander
Highest level of education completed
*
GED
High School
Some College
Bachelor Degree
Other
Honors Received
State any additional information you feel may be helpful to us in considering your application.
I understand that information I provide regarding current and/or previous employers may be used and those employer(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.
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
Name
*
First
Last
Date
*
MM slash DD slash YYYY
Veteran of the U.S. Military service?
*
Yes
No
If Yes, Branch
Indicate languages you speak, read, and/or write.
*
List Professional, trade, business or civic activities and offices held.
*
(You may exclude those which indicate race, color, religion, sex or national origin)
Give name, address and telephone number of three references who are not related to you and are not previous employers.
*
Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
If you wish to be identified, please sign below.
Handicapped Individual
Disabled Veteran
Vietnam Era Veteran
Name
First
Last
EMPLOYMENT HISTORY
Business Name
*
First
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Person
*
First
Last
Phone
*
Employed From Date
*
MM slash DD slash YYYY
Employed To Date
*
MM slash DD slash YYYY
Position Held
*
Starting Wage
Ending Wage
Reason For Leaving
*
Were you subject to the FMCSRs while employed?
*
Yes
No
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?
*
Yes
No
Name
Business Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Employed From Date
MM slash DD slash YYYY
Employed To Date
MM slash DD slash YYYY
Position Held
Starting Wage
Ending Wage
Reason For Leaving
Were you subject to the FMCSRs while employed?
Yes
No
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?
Yes
No
Name
Business Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Employed From Date
MM slash DD slash YYYY
Employed To Date
MM slash DD slash YYYY
Position Held
Starting Wage
Ending Wage
Reason For Leaving
Were you subject to the FMCSRs while employed?
Yes
No
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?
Yes
No
Name
Business Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Employed From Date
MM slash DD slash YYYY
Employed To Date
MM slash DD slash YYYY
Position Held
Starting Wage
Ending Wage
Reason For Leaving
Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience
Were you subject to the FMCSRs while employed?
Yes
No
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?
Yes
No
Name
Business Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Employed From Date
MM slash DD slash YYYY
Employed To Date
MM slash DD slash YYYY
Position Held
Reason For Leaving
Were you subject to the FMCSRs while employed?
Yes
No
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?
Yes
No
*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 interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 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. Id none, write none.
Date
MM slash DD slash YYYY
Nature of Accident
(Head-on, Rear-end, Upset, etc)
Fatalities?
Yes
No
Injuries?
Yes
No
Hazardous Material Spill?
Yes
No
Date
MM slash DD slash YYYY
Nature of Accident
(Head-on, Rear-end, Upset, etc)
Fatalities?
Yes
No
Injuries?
Yes
No
Hazardous Material Spill?
Yes
No
Date
MM slash DD slash YYYY
Nature of Accident
(Head-on, Rear-end, Upset, etc)
Fatalities?
Yes
No
Injuries?
Yes
No
Hazardous Material Spill?
Yes
No
TRAFFIC CONVICTIONS
And forfeitures for the past 3 years (other than parking violations). If none, write none.
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
EXPERIENCE AND QUALIFICATIONS - DRIVER
Driver licenses or permits held in the past 3 years
State
License Number
Class
Endorsements
Expiration Date
MM slash DD slash YYYY
State
License Number
Class
Endorsements
Expiration Date
MM slash DD slash YYYY
State
License Number
Class
Endorsements
Expiration Date
MM slash DD slash YYYY
State
License Number
Class
Endorsements
Expiration Date
MM slash DD slash YYYY
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Has any license, permit or privilege ever been suspended or revoked?
Yes
No
If the answer to either of these is yes, give details
DRIVING EXPERIENCE - CLASS OF EQUIPMENT
Straight Truck
Yes
No
Select Type Of Equipment
Van
Tank
Flat
Dump
Refer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Tractor and Semi-Trailer
Yes
No
Select Type Of Equipment
Van
Tank
Flat
Dump
Refer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Tractor and Two Trailers
Yes
No
Select Type Of Equipment
Van
Tank
Flat
Dump
Refer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Tractor and Three Trailers
Yes
No
Select Type Of Equipment
Van
Tank
Flat
Dump
Refer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Motorcoach - School Bus (More than 8 passengers)
Yes
No
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Motorcoach - School Bus (More than 15 passengers)
Yes
No
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
Other
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. Number Of Miles (Total)
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
List courses and training other than shown elsewhere in this application
List special equipment or technical materials you can work with (other than those already shown)
Have you ever worked or driven for a professional moving company before?
*
Yes
No
If yes, what did you do?
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.
Name
First
Last
Date
MM slash DD slash YYYY
89162