Drivers Online Application for Employment

Personal Information

*Last Name     *First Name    *Mid Init  Suffix

  Maiden Name 

*Street Address

  Address Line 2

*City     *ST     *ZIP CODE

 

*Social Security Number     *Date of Birth  

*Home Phone Number         Email Address

 

*Previous Addresses:

  (List all previous addresses for the past five years)

      

 

*Are you eligible to work in the United States? Yes  No

*Are you available to work fulltime Yes No

 

 

Emergency Notification

*Notify in case of emergency:  Name     *Address

*City   *St      *Zip       *Phone

*Relationship 

 

License Information

*Drivers License Number  *Expiration Date

*Drivers License State 

*Drivers License Type

 

(To select more than one endorsement hold the CTRL key while you click on your endorsements)

 

*List all driver licenses you have held in the past 36 months

    (include state, type, and expiration date):

     

 

*How long have you held a CDL/Chauffeur's License? 

Education *Select highest grade completed     Last school attended

 

Truck driving school name     Location 

Graduation Date

 

 

*Driving Position Applying For:

*How many years of verifiable experience do you have driving a tractor trailer? 

*How did you hear about CoreTrans?     Referred by:

*Have you ever been employed by CoreTrans?  Yes   No

If yes when?  From until

 

 

*Have you ever been convicted of a misdemeanor?  Yes   No

If yes, please provide date(s) and explanation below:

 

*Have you ever been convicted of a felony?  Yes   No

If yes, please provide date(s) and explanation below:

 

*Have you ever been convicted of a DUI, DWI, careless or reckless driving?  Yes   No

If yes, please provide date(s) and explanation below:

 

*Have your driver's license ever been suspended or revoked?  Yes   No

If yes, please provide date(s) and explanation below:

 

*Have you ever failed a drug test?  Yes   No

f yes, please provide date(s) and explanation below:

 

*List all moving violation in last 36 months:

     Date                 Violation                                Location

1) 

2) 

3) 

4) 

5) 

 

 

*List all accidents you have been involved in the last 36 months regardless of fault or type of vehicle:

  

         

1)

2)

3)

4)

 

Military

*Have you ever served in the U.S. Armed Forces?  Yes  No 

*If yes, what branch?   Date entered     Date Discharged

*Type of discharge     Reserve status

 

Physical Condition

*Do you have a current D.O.T. Physical Certificate?  Yes   No

*If yes, name of doctor   *Address

*Exam Date

 

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.

Current or Most Recent Employer

*Employer Name

*Address 

*City   *State   *Zip

*Phone     *Position   

*Start Date     *End Date   *Reason for leaving

*Supervisor

*May we contact your current employer? Yes   No

*Equipment Operated           *Rate of Pay per

 

Unemployment period from to

 

Previous Employer 2

Employer Name

Address 

City   State   Zip

Phone     Position   

Start Date     End Date   Reason for leaving

Supervisor

Equipment Operated           Rate of Pay per

 

Unemployment period from to

 

Previous Employer 3

Employer Name

Address 

City   State   Zip

Phone     Position   

Start Date     End Date   Reason for leaving

Supervisor

Equipment Operated           Rate of Pay per

 

Unemployment period from to

 

Previous Employer 4

Employer Name

Address 

City   State   Zip

Phone     Position   

Start Date     End Date   Reason for leaving

Supervisor

Equipment Operated           Rate of Pay per

 

Unemployment period from to

 

Previous Employer 5

Employer Name

Address 

City   State   Zip

Phone     Position   

Start Date     End Date   Reason for leaving

Supervisor

Equipment Operated           Rate of Pay per

 

Unemployment period from to

 

References *Please list three references (no relatives) we may contact.

 

 

DRIVER NOTIFICATION AND RELEASE

In connection with my application for employment (including contract for services) with you, I understand that a consumer report, which may contain public record information, is being requested from DAC Services, Tulsa, Oklahoma.  This report may include the following types of information:  names and dates of previous employers, reason for termination of employment, work experience, accidents, etc.  I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies and state provided driving records.

 

I authorize, without reservation, any party or agency contacted by DAC or CoreTrans, LLC to furnish the above-mentioned information.

 

I further certify that I personally completed this application and that all of the information is true and accurate.  I authorize CoreTrans, LLC to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by CoreTrans, LLC, including but not limited to information required by 391.23 of the Motor Carrier Safety Regulations, and hold them harmless of all liability from the release of said information.