Phone - 800-423-0478     Local - 256-586-3018     Fax - 256-586-8881     Web - www.arabcartage.com

Driver Employment Application
(answer all questions )
 In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions
without regard to race, color, religion, sex, national origin, age, marital status, military or veteran status, or disability.

Applicant Name  and  Social Security Information

Last Name    First Name   Middle Name   

Social Security Number               Date of Application -- mm/dd/yy

Applicant Contact Information
Address
                

City     State     Zip 		Phone
Email:

Address for the past 3 years
Address     City       State       Zip

Address     City       State       Zip

Address     City       State      Zip

 

Do you have the legal right to work in the United States?       Yes      No   

Date of Birth?          Can you provide proof of age? Yes     No   

Have you worked for this company before? Yes    No    
If yes provide dates? 
Date>   Position>    Reason for leaving>
Date>   Position>    Reason for leaving>

Are you employed now? Yes    No           If not, how long since leaving last emplyment

Who referred you?                    Rate of pay expected   

Physical History   (49 C.F.R. SS391.41)

Are you physically qualified to operate a commercial motor vehicle? Yes    No

Can you provide proof that you are physically certified to operate a commercial motor vehicle? Yes    No
For the purposes of complying with 49 C.F.R. SS391.45,
when was the date of your most recent physical examination:  

Are you able to perform heavy manual work? Yes    No

Employment History   (49 C.F.R. SS391.21(b)(10) & (11))

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding
3 years. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional
7 years' information on those employers for whom the applicant operated such vehicle.
(Note: List employers in reverse order starting with the most recent. Add another sheet if necessary)

Previous Employer             Phone

Address

City   State    Zip
Start Date    End Date
Position Held  
Wage Salary
Reason for leaving   
Were you subject to FMCSR regulations while employed?  Yes    No
Was this job designated asa safety sensitive function
in which you were subject to alcohol and controlled substance testing?  Yes    No
  

Previous Employer             Phone

Address

City   State    Zip
Start Date    End Date
Position Held  
Wage Salary
Reason for leaving   
Were you subject to FMCSR regulations while employed?  Yes    No
Was this job designated asa safety sensitive function
in which you were subject to alcohol and controlled substance testing?  Yes    No
  

Previous Employer             Phone

Address

City   State    Zip
Start Date    End Date
Position Held  
Wage Salary
Reason for leaving   
Were you subject to FMCSR regulations while employed?  Yes    No
Was this job designated asa safety sensitive function
in which you were subject to alcohol and controlled substance testing?  Yes    No
 

Previous Employer             Phone

Address

City   State    Zip
Start Date    End Date
Position Held  
Wage Salary
Reason for leaving   
Were you subject to FMCSR regulations while employed?  Yes    No
Was this job designated asa safety sensitive function
in which you were subject to alcohol and controlled substance testing?  Yes    No

Personal Information

Check One:    Single    Engaged    Married    Separated     Divorced     Widowed

Number of Dependants         Age of Dependants

Do you own your home or rent?        Average monthly living expenses?

Is your spouse working? Yes    No          If yes Where?  

Incase of Emergency we should contact?
Name      Address      Phone

MVR & Background Check Information   (49 C.F.R. SS391.21(a)(7-9))

 Accident record for past 3 years or more (attach sheet if more space is needed). If none, write "none".

                        Dates of Violation                              Nature of Accident                                   Injuries                Fatalities
                                                                  (Head-On, Rear-End, Single Vehicle, Etc.)

Last Accident                                                   
Next Previous                                                  
Next Previous                                                  

 

 Traffic Convictions and forfeitures for the past 3 years (other than parking violations). If none, write "none".".

                           Location                                        Date                              Charge                                    Penalty                       

                        
                        
                        

 

A) Have you ever been denied a license, permit, or privilege to operate a motor vehicle?  Yes    No
B) Has any license, permit or privilege ever been revoked?  Yes    No
C) Have you ever been arrested or convicted of a felony or misdemeanor?  Yes    No
 D) Have you ever had a warrant issued for your arrest?  Yes    No

If you answered yes to any of the above provide details below.

Education

Highest Grade Completed: (Enter the highest grade completed beside the appropriate heading)
Primary 1 2 3 4 5 6 7 8
High School: 9 10 11 12
College: 1 2 3 4
Name of last school attended?

 

Experience and Qualifications  -  Driver   (49 C.F.R. SS391.21(a)(5-6))

Drivers License Info

             State                                          License No.                                  Type                                     Expiration Date
                                  
                                  
                                  
                                  

Driving Experience  -  Driver  (49 C.F.R. SS391.21(a)(5-6))
Equipment Class
Straight Truck
Tractor Trailer
Doubles or Triples
Motor coach or Bus
Other 		   Type of Equipment                               Dates                                  Approx. No. of Miles
 (Van,Tanker,Flat,etc)                   From                   To
                        
                        
                        
 

List states operated in for last 5 years
                  
                  
                  

List special courses taken that will help you as a driver
 

List safe drive awards you hold and from whom?
 

Show any trucking, transportation, or other experience that may help in your work for this company:

To Be Read and 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 inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries 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 inquires 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 may result in discharge. I understand, also, that I am required to abide by all rules and regulation of the Company.

I have read and agree the above terms
      

 

Copyright © 2007 Arab Cartage Express. All rights reserved.
Revised: 04/10/07