Commercial Driver Application – Signature Transport Inc

APPLICANT INFORMATION

Date

Position Applying For

Driver

First Name *

Middle Name *

Last Name *

Phone *

Email *

Emergency Phone *

Age

(The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.)

Social Security #

Date of Birth

Drivers License #

DL State

DL Exp. Date

DOT / Medical Physical Exam Expiration Date

Current & 3 Years Previous Addresses:

Current Address

From

To

Add Address Remove Address

STI History

Have You Worked For STI Before? *

Yes

No

From

If Yes, provide dates.

To

Reason For Leaving

If it was an Employee who?

Education History

Please Select The Highest Grade Completed

Employment History

Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self-employment periods, and all commercial driving experience for the past ten (10) years.

From

To

Present or Last Employer Name

Position Held

Reason For Leaving

Company Phone

Address

City

State/Province

Zip/Postal

Add More Remove

Driving Experience

Straight Truck

From

To

Approximate Number of Miles

Tractor & Semitrailer

From

To

Approximate Number of Miles

Tractor & Doubles

From

To

Approximate Number of Miles

Tractor & Triples

From

To

Approximate Number of Miles

Driving Experience (continue)

List states operated in, for the last five (5) years

List special courses/training completed (PTD/DDC, HAZMAT, ETC)

List any Safe Driving Awards you hold and from whom

What YEAR did you get your CDL?

Please attach a current Drivers Abstract for past three (3) years

Maximum upload size: 268.44MB

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

No

Has any license, permit or privilege ever been suspended or revoked?

Yes

No

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?

Yes

No

Have you ever been convicted of a felony?

Yes

No

If the answers to any questions listed above are “yes”, give details

Job References

List three (3) persons for references, other than family members, who have knowledge of your safety habits.

Name

Address

Phone

Name

Address

Phone

Names

Address

Phone

I have read and agree:

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

I have read and agree:

It is agreed and understood that the Signature Transport, Inc. or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information.

I have read and agree:

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 investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I have read and agree:

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

I have read and agree:

It is agreed and understood that this Application in no way obligates the Signature Transport, Inc. to employ or hire the applicant.

I have read and agree:

It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

I have read and agree:

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 have read and agree:

THIS CERTIFIES THAT I HAVE READ AND RECEIVED A COPY OF THE "APPLICANTS RIGHTS".

Click here to read the DOT REGULATED DRIVER APPLICANT'S RIGHTS

I have read and agree:

THIS CERTIFIES THAT I HAVE READ AND AGREE TO THE Disclosure Regarding Background Reports

Click here to read the DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP

Equal Employment Opportunity "Employee Questionnaire" for Self-Identification of Race/Ethnicity

Click here to read the Anti-Discrimination Notice

Gender

Male

Female

Definitions of race/ethnicity are below (as defined by the Equal Employment Opportunity Commission).

Race/Ethnic Identification (check one):

Are you Hispanic or Latino?

Yes

No

I Choose NOT to Self-identify my race/ethnicity at this time, and understand my employer will choose for me.

If you answered "No" please select a race from the options below:

White (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

American Indian or Alaska Native (Not Hispanic or Latino)

Two or More Races (Not Hispanic or Latino)

Definitions of race/ethnicity are (as defined by the Equal Employment Opportunity Commission):

Hispanic of Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

Request for Check of Driving Record

I agree:

Please provide the following information to Signature Transport, Inc. for the purpose of completing investigations required under CFR Part 391.23, 25. You are released from any and all liability which may arise. as a result of information contained in the requested report.

I agree:

In accordance with the provisions of Section 604 and Section 607 of the Fair Credit Reporting Act, Public Law No. 91-508, I certify that the information requested below will be used for a "permissible purpose" as defined in the Act, and that the information received will be used for no other purposes.

I agree:

I am authorized to obtain personal information for motor vehicle records. Information obtained through this report will be used solely in the normal course of business for verifying the accuracy of driving information supplied by the named individual here for the purpose of verifying eligibility to be considered as a commercial motor vehicle driver as defined in Title 49 CFR Parts 382, 383 and 391.

REQUESTED BY: Signature Transport, Inc., Tammy Catlin-Toney - HR Director

TO:

OR DMV Records, 1905 Lana Ave NE, Salem, OR 97314-2250
WA Dept. of Licensing, Driver Record Section, PO Box 9030, Olympia, WA 98507-9030
ID Transportation Dept., Driver Services Section, PO Box 34, Boise, ID 83731
NV DMV & PS, Motor Vehicle Records Section, 555 Wright Way, Carson City, NV 89611-9250
CA Dept. of Motor Vehicles, Information Services Branch, PO Box 944247, G-199, Sacramento, CA 94244-2470

The following named individual has made application with our company as a driver of a commercial motor vehicle requiring us to obtain and review his/her motor vehicle driving record for the past 3 years, and on an annual basis thereafter, while retained by Signature Transport, Inc. as a driver. CFR Part 391.23

Signature

Clear

Todays Date

Drive for Signature Transport Inc.

Commercial Driver Job Application

APPLICANT INFORMATION

Current & 3 Years Previous Addresses:

STI History

Education History

Employment History

Driving Experience

Straight Truck

Tractor & Semitrailer

Tractor & Doubles

Tractor & Triples

Driving Experience (continue)

Job References

Equal Employment Opportunity "Employee Questionnaire" for Self-Identification of Race/Ethnicity

Request for Check of Driving Record