Texcon Driver’s Application for Employment

List you addresses of residency for the past 3 years

Current Address*

How long at current address?*

Previous Address 1*

How long at Previous Address 1*

Previous Address 2*

How long at Previous Address 2

Personal Information

Do you have the legal right to work in the United States?*

Date of Birth*

Can you provide proof of age?*

Have you worked for this company before?*

If Yes, Where?

If Yes, Previous hire date?

If Yes, Previous end date?

If Yes, Previous rate of pay?

If Yes, Previous position

If Yes, Reason for leaving?

Are you now employed?*

If No, How long since leaving last employment?

Have you ever been bonded?*

If Yes, Name of bonding company

Have you ever been convicted of a felony?*

If Yes, please explain fully. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

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)?*

If Yes, explain, if you wish.

EMPLOYMENT HISTORY

Employer 1 Name

Employer 1 Address

Employer 1 City

Employer 1 State

Employer 1 Zip

Employer 1 Contact Person

Employer 1 Phone Number

A valid phone number is required.

Employer 1 Date From:

Employer 1 Date To:

Employer 1 Position Held

Employer 1 Salary/Wage

Employer 1 Reason for leaving

Employer 1 Were you subject to FMCSRs while employed?

Yes No

Employer 1 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 46 CFR Part 40?

Yes No

Employer 2 Name

Employer 2 Address

Employer 2 City

Employer 2 State

Employer 2 Zip

Employer 2 Contact Person

Employer 2 Phone Number

A valid phone number is required.

Employer 2 Date From:

Employer 2 Date To:

Employer 2 Position Held:

Employer 2 Salary/Wage

Employer 2 Reason for Leaving

Employer 2 Were you subject to FMCSSRs while employed?

Yes No

Employer 2 Was your job designated as a safety sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 46 CFR Part 40?

Yes No

Employer 3 Name

Employer 3 Address

Employer 3 City

Employer 3 Zip

Employer 3 State

Employer 3 Contact

Employer 3 Phone Number

A valid phone number is required.

Employer 3 Date From:

Employer 3 Date To:

Employer 3 Position Held

Employer 3 Salary/Wage

Employer 3 Reason for leaving

Accident Record for past 3 years or more

Last Accident Date

Nature of accident (Head-on, rear-end, upset, etc))

Fatalities

Injuries

Hazardous Material Spill

Next Previous Accident Date

Traffic convictions and forfeitures for the past 3 years (other than parking violations), if none, enter none.

Most Recent Location

Date

Charge

Penalty

Next previous - Location

EXPERIENCE AND QUALIFICATIONS - DRIVER. List all driver licenses and permits held in the past 3 years.

License No.

Type

Expiration Date

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

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

If the answer to either of the above 2 questions is yes, please give details.

DRIVING EXPERIENCE

Straight Truck*

Yes No

Straight Truck Type of Equipment

Straight Truck Dates From:

Straight Truck Dates To:

Straight Truck Approximate number of miles

Tractor and semi-trailer*

Yes No

Tractor and semi-trailer Type of Equipment

Tractor and semi-trailer Dates From:*

Tractor and semi-trailer Dates To:

Tractor and semi-trailer approximate number of miles

Tractor - Two Trailers*

Yes No

Tractor - Two Trailers Type of Equipment

Tractor - Two Trailers Dates From:

Tractor - Two Trailers Dates To:

Tractor - Two Trailers Approximate number of miles

Tractor - Three Trailers*

Yes No

Tractor - Three Trailers Type of Equipment

Tractor - Three Trailers Dates From:

Tractor - Three Trailers Dates To:

Tractor - Three Trailers Approximate number of miles

Motorcoach - School Bus More than 16 pass*

Yes No

Motorcoach - School Bus Date From

Motorcoach - School Bus Date To

Motorcoach - School Bus Approximate number of miles

Motorcoach - School Bus More than 8 pass*

Yes No

Motorcoach - School Bus More than 8 pass Date From:

Motorcoach - School Bus More than 8 pass Date To:

Motorcoach - School Bus More than 8 pass Approximate number of miles

List states operated in for the last five years*

Show special courses or training that will help you as a driver:*

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

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

List courses and training other than shown elsewhere on the applicaiton*

List special equipment or technical materials you can work with (Other than already shown)*

EDUCATION

Highest grade completed

High School

College

Last school attended (Name, City, and State))*

I, the applicant, certify 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. certifie*

Yes No

Apply Online

List you addresses of residency for the past 3 years

Personal Information

EMPLOYMENT HISTORY

Accident Record for past 3 years or more

Traffic convictions and forfeitures for the past 3 years (other than parking violations), if none, enter none.

EXPERIENCE AND QUALIFICATIONS - DRIVER. List all driver licenses and permits held in the past 3 years.

DRIVING EXPERIENCE

Tractor and semi-trailer Type of Equipment

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION