Employment - Miner's Towing

Employment

Driver's Application for Employment

1Applicant Information

2Employment History

3Accident History

4Driving History

5Education

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, veteran status, non-job related disability, or any other protected group status.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to;  Review information provided by previous employers;  Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and  Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Applicant's Name(Required)

First Middle Last

Phone

Current Company

Position(s) Applied for(Required)

Social Security No.

List your addresses of residency for the past 3 years

Current Address

Street Address City State / Province / Region ZIP / Postal Code Country

Previous Addresses

Street

City

State

Zip Code

How long?

Do you have the legal authority to work in the United States?(Required)

Yes

Date of Birth(Required)

Required for Commercial Drivers

Can you provide proof of age?(Required)

Yes

Have you worked for this company before?(Required)

Yes

From(Required)

MM slash DD slash YYYY

Date

To(Required)

MM slash DD slash YYYY

Date

Rate of pay(Required)

Position?(Required)

Reason for Leaving(Required)

Are you now employed?(Required)

Yes

If not, how long since leaving last employment?

Have you ever been in an accident?(Required)

Yes

Who Referred you ?

Rate of pay expected

Have you ever been bonded?

Yes

Name of bonding company

Have you ever been convicted of a felony?(Required)

Yes

If yes, please explain fully. Conviction of a crime is not an automatic bar to employment – all circumstances will be considered.(Required)

Can you perform, with or without reasonable accommodation, the essential functions of the job (as described in the attached job description)?

Yes

If yes, explain if you wish

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive 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 as necessary.)

Employer Address

Street Address City State / Province / Region ZIP / Postal Code Country

Position held

From

Date

Reason for leaving

Were you subjected to the FMCSRs* while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40

Yes

Employer Address

Street Address City State / Province / Region ZIP / Postal Code Country

Position held

From

Date

Reason for leaving

Were you subjected to the FMCSRs* while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40

Yes

Employer Address

Street Address City State / Province / Region ZIP / Postal Code Country

Position held

From

Date

Reason for leaving

Were you subjected to the FMCSRs* while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

Employer Address

Street Address City State / Province / Region ZIP / Postal Code Country

Position held

From

Date

Reason for leaving

Were you subjected to the FMCSRs* while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

*Includes vehicles having a GVWR of 26,001 Ibs. or more, vehicles designed to transport 16 or more passengers (including driver), or any size vehicle used to transport hazardous materials in quantity requiring placarding. The Federal Motor Carrier Safety Regulations (FMCSFs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers of property when the vehicle: (1) weighs or has a GVWR of 10,001 Ibs. or more, (2) is designed or used to transport more than 8 passengers (including the driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD FOR PAST 3 YEARS

IF NONE, WRITE NONE

Accident

Date

Nature of Accident

Fatalities

Injuries

Hazard Materials Spill

TRAFFIC CONVICTIONS AND FOREITURES FOR THE PAST 3 YEARS

(OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Information

Location

Date

Charge

Penalty

DRIVING EXPERIENCE

STRAIGHT TRUCK

Yes

EQUIPMENT

(VAN, TANK, FLAT, DUMP, REFER)

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

TRACTOR AND SEMI-TRAILER

Yes

EQUIPMENT

(VAN, TANK, FLAT, DUMP, REFER)

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

TRACTOR – TWO TRAILERS

Yes

EQUIPMENT

(VAN, TANK, FLAT, DUMP, REFER)

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

TRACTOR – THREE TRAILERS

Yes

EQUIPMENT

(VAN, TANK, FLAT, DUMP, REFER)

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

MOTORCOACH – SCHOOL BUS

Yes

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

OTHER

DATES

FROM (M/Y) TO (M/Y)

APPROX. NO. OF MILES

(TOTAL)

LIST STATES OPERATED IN FOR 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 – DRIVER

LIST ALL DRIVER LICENSES OR PERMITS HELD IN PAST 3 YEARS

Driver License Information

State

License Number

Type

Expiration Date

When did you first receive your CDL?(Required)

MM slash DD slash YYYY

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

Yes

B. Has any license, permit or privileges ever been suspended or revoked?

Yes

If the answer to either A or B is Yes, give details

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 IN THIS APPLICATION

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)

EDUCATION

HIGHEST GRADE COMPLETED

HIGH-SCHOOL

COLLEGE

Signature

CAPTCHA

CONTACT US

(636) 349-1975
(636) 600-0883
office@minerstowing.com
12960 Gravois Rd. St. Louis, MO 63127
Live Dispatch 24/7
Office Hours:
Mon - Fri: 8am - 5pm
Saturday: 9am - 1pm
Sunday: Closed

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