APPLICATION FOR EMPLOYMENT

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information to all employers during the preceding 3 years. (List employers in reverse order starting with the most recent.)

EDUCATION

REFERENCES: GIVE THE NAMES OF 3 PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN 

AT LEAST ONE YEAR

PHYSICAL RECORD

INCASE OF EMERGENCY NOTIFY

EXPERIENCE & QUALIFICATIONS - DRIVER

ACCIDENT RECORD FOR PAST THREE YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED)

LAST ACCIDENT

CLASS OF EQUIPMENT

DATES

EXPERIENCE & QUALIFICATION – OTHER

TO BE READ & SIGNED BY APPLICANT

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.

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. I hereby release employers, schools or persons from all liability in responding to inquires 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, as permitted by Law.