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| DRIVER
PRE-APPLICATION FOR EMPLOYMENT |
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| Referred By |
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| Your Name |
Last |
First M.I. |
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| *Social Security No |
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| Phone |
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| *Date of Birth: |
Are you
at least 23 years old? |
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| Present Address: |
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| City |
State Zip |
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| How long? |
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| *Driver's License
Number: |
State |
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| Email Address |
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| Do you currently hold a
valid class A, Commercial Driver's License (CDL)? YES
NO |
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| Check off endorsements
held: Tank
Double-Triple
Haz-Mat
Passenger
School
Tank with Hazmat |
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| Have you ever been
convicted of a felony? YES
NO
If yes, when? |
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| How many chargeable
accidents have you had in the past 3 years? |
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| Has your license ever
been suspended or revoked? YES
NO
If yes, when? |
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| EDUCATION |
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| Check highest grade
completed |
10 11
12 |
| Technical/Trade School |
1 2
3 |
| College |
1 2
3 4
5 6
7 8 |
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| PREVIOUS
EMPLOYMENT |
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| From |
To |
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| Company Name |
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| Phone |
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| Address |
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| City |
State
Zip |
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| Position Held |
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| Reason for leaving |
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| Starting Wages |
Ending Wages |
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| From |
To |
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| Company Name |
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| Phone |
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| Address |
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| City |
State
Zip |
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| Position Held |
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| Reason for leaving |
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| Starting Wages |
Ending Wages |
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| From |
To |
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| Company Name |
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| Phone |
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| Address |
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| City |
State
Zip |
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| Position Held |
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| Reason for leaving |
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| Starting Wages |
Ending Wages |
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| Total years driving
experience |
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| *To
obtain your Motor Vehicle Record, we need this information. |
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We appreciate
your interest in
WHW INC. TRUCKING
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IT IS OUR
POLICY TO CHECK EACH CANDIDATE'S BACKGROUND THOROUGHLY
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| I understand that the
information in this form will be used and that prior employers will be
contacted for purposes of investigation as required by 391.23 of the
Motor Carrier Safety Regulations. I authorize release of any
information, including all information related to my alcohol and
controlled substances testing and training records, by any former
employers and hold them harmless of any liability from release of said
information. |
