Application For a Driver

Commercial Driver Application for Employment

Use the form below to inquire about employment opportunities with our company.

Step 1 of 5

20%

Date
Company Name
Street Address
City, State, Zip
Applicant Name
First Middle Last
Home Phone
Cell Phone
* Current Address
Street Address City State / Province / Region ZIP / Postal Code
* If at the above residence less than three years, list below all residences for the past three years. Attach a separate sheet if necessary.

Street Address City State ZIP Code
Street Address City State ZIP Code
Position Applying for
- Temporary
- Part Time
- Full Time
Who Referred You ?
Rate of Pay Expected ?
Have you ever worked for this company before?
- Yes
- No
Dates:
From To
Where? Rate of Pay Position
Reason for Leaving?
Names of any relatives employed by this company
Are you currently employed?
If not, how long since leaving last employment?
EDUCATION
Circle highest grade completed:
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
College:
- 1
- 2
- 3
- 4
Last school attended
Name Address
MILITARY EXPERIENCE
Have you ever served in the U.S. Armed Services?
- Yes
- No
If yes, which branch of service:
Describe any military training received relevant to the position for which you are applying.
Are you currently serving in Military Reserves?
- Yes
- No
Are you currently serving in National Guard?
- Yes
- No
GENERAL
Have you ever been bonded?
(Answer only if a job requirement)
Name of bonding company
Have you ever been convicted of a felony?
- Yes
- No
If yes, please explain below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

ACCIDENT HISTORY
Accident Review for the past 3 years (attach a separate sheet of paper if more space is needed).
Date Nature of Accident (Head-On, Rear-End, Upset, etc) # Fatalities # Injuries # Vehicles Towed Citation Issued?
MOTOR VEHICLE DRIVING RECORD (MVR)
Traffic Convictions and Forfeitures for the past 3 years other than parking violations.
Date Location Charge Penalty
EMPLOYMENT RECORD
The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.

Start with the last or current position, including any military experience, and work back (Attach separate sheet if necessary.) You are required to list the complete mailing address: street number, city, state and zip code.
Current Employer: Supervisor’s Name:
Position Held: From To Salary
Address: Phone:
Reason for Leaving:
Previous Employer: Supervisor’s Name:
Address: Phone:
Position Held: From To Salary
Reason for Leaving:
Previous Employer: Supervisor’s Name:
Address: Phone:
Position Held: From To Salary
Reason for Leaving:
Previous Employer: Supervisor’s Name:
Address: Phone:
Position Held: From To Salary
Reason for Leaving:
Previous Employer: Supervisor’s Name:
Address: Phone:
Position Held: From To Salary
Reason for Leaving:
Previous Employer: Supervisor’s Name:
Address: Phone:
Position Held: From To Salary
Reason for Leaving:

APPLICANT MUST READ AND SIGN
I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.

This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.
Date
Applicant’s Signature

MIG Express LLC

Commercial Driver Application for Employment

Step 1 of 5

EDUCATION

MILITARY EXPERIENCE

GENERAL

DRIVER EXPERIENCE AND QUALIFICATIONS

PHYSICAL HISTORY

ALCOHOL AND CONTROLLED SUBSTANCE STATEMENT

DRIVER’S LICENSE INFORMATION

DRIVING EXPERIENCE

ACCIDENT HISTORY

MOTOR VEHICLE DRIVING RECORD (MVR)

EMPLOYMENT RECORD

APPLICANT MUST READ AND SIGN

FOR OFFICE USE - DO NOT WRITE IN THIS SPACE PROCESS RECORD

THIS SECTION TO BE FILLED IN BY OFFICER OR COMPANY REPRESENTATIVE

Termination of Employment

USE THIS SHEET FOR ADDITIONAL EMPLOYMENT HISTORY INFORMATION