DRIVER APPLICATION FOR EMPLOYMENT

Date: *

First Name: *

Middle Name:

Last Name: *

Email: *

Birth Date: *

Phone Number: *

Current Address-1: *

Current Address-2: *

Current State: *

Current Zip Code: *

Current City: *

Previous Address-1:

Previous Address-2:

Previous State:

Previous Zip Code:

Previous City:

Do You Have The Legal Right To Work In The United States? *

Yes

Do You Have Proof Of Age? *

Yes

Is there any reason you might be unable to perform the function of the job for which you have applied? if yes, please explain:

EMPLOYMENT HISTORY

10 year work history required

Company Name:

Position:

From:

To:

Address-1:

State:

Zip Code:

City:

Contact:

Contact Phone:

Reason For Leaving:

Driving Experience

Accident Records

FOR THE PAST 3 YEARS

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Date Of Accident:

Nature Of Accident:

Fatalites:

Yes

Injuries:

Yes

Traffic Convictions

FOR THE PAST 3 YEARS

Date:

Location:

Charge:

Penalty:

Education

FOR THE PAST 3 YEARS

Highest Grade Attended:

Middle School

High School

Associate Degree

Undergrad

Last School Attended:

City:

Experience And Qualifications

State:

License #:

Type:

Expiration Date:

Have You Ever Been Denied A License, A Permit, Or The Privilege To Operate A Motor Vehicle:

Yes

Has Any License, Permit, Or Privilege Ever Been Suspended Or Revoked:

Yes

IF THE ANSWER IS YES TO EITHER QUESTION ABOVE ATTACH REASONING

Attach Here:

Which Safe Vehicle Awards Do You Hold And From Whom?:

Vehicle Maker:

Vehicle Model:

Vehicle Year:

Vehicle Plated At:

Do you have a passport?

Yes

Are You Able And Willing To Transport Into Canada?

Yes

Have You Ever Been Convicted Of A Crime?

Yes

If yes, Explain:

To Be Read And Signed By Applicant

This certifies that this application was completed by me and that all entries on it and information are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires 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 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.

Signature *

Date

Disclosure And Release

In connection with my application for employment with Southeastern Trailer Transport, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa Oklahoma. These reports 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 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 request made by others from such state agencies, and state provided driving records. I AUTHORIZE, WITHOUT RESERVATION; ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION. I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously within the two year period preceding my request. I hereby consent to Southeastern Trailer Transport obtaining the above information from DAC, and I agree that such information from DAC, and I agree that such information which DAC has or obtains, and my employment history with Southeastern Trailer Transport, if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services. I hereby authorize procurement of consumer report(s). If hired, this authorization shall remain on file and shall serve as ongoing authorization for Southeastern Trailer Transport to procure consumer reports at any time during my employment period.

Print Name:

Date:

Applicants Signature *

DRIVER'S APPLICATION FOR EMPLOYMENT

EMPLOYMENT HISTORY Add Another Employment History

10 year work history required

Driving Experience

Accident Records Add Another Accident

FOR THE PAST 3 YEARS

Traffic Convictions Add Another Traffic Conviction

Education

Experience And Qualifications

To Be Read And Signed By Applicant

Disclosure And Release

EMPLOYMENT HISTORY

Accident Records

Traffic Convictions