Driver Application

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1 Step 1

Wolverine Haulers, LLC

3130 Glade St STE B

Muskegon Heights, MI 49444

Personal Information
Today's Date
First Name
Last Name
Position Applying For
Phone Number
Emergency Phone
Age(The Age Discrimination of Emp. Act of 1967 prohibits discrimination on the basis of age w/ respect to individuals who are at least 40 but less than 70 yrs of age.)
Date of Birthmonth/day/year
Physical Exam Expiration Date
Current Address
Dates
Previous Address
Dates
Previous Address
Dates
Have You Worked for this Company Before?
Dates
Reason for Leaving
Education History

Please check the highest grade completed:

Grade School:
College
Post Graduate
Employment

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


Employment History
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
Were you subject to the FMCSRs while employed here?
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?
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
Were you subject to the FMCSRs while employed here?
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?
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
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?
Were you subject to the FMCSRs while employed here?
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
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?
Were you subject to the FMCSRs while employed here?
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
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?
Were you subject to the FMCSRs while employed here?
Employer Name
City
Telephone
Your Position
Starting Date
Ending Date
Reason for Leaving?
0 / 500
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?
Were you subject to the FMCSRs while employed here?
Driving Experience

Class of Equipment

Straight Truck


Fromyour full name
Toyour full name
Approx. # of Milesyour full name

Tractor & Semi-Trailer


Fromyour full name
Toyour full name
Approx. # of Milesyour full name

Tractor & Two Trailers


Fromyour full name
Toyour full name
Approx. # of Milesyour full name

Tractor & Triple Trailers


Fromyour full name
Toyour full name
Approx. # of Milesyour full name

Other


Fromyour full name
Toyour full name
Approx. # of Milesyour full name
List states operated in, for the last five (5) yearsyour full name
List special courses/training completed (PTD/DDC, HAZMAT, ETC)your full name
List any Safe Driving Awards you hold and from whomyour full name

Accident Record for past three (3) years: (attach sheet if more space is needed):

Date of Accident
Nature of Accidents(Head On, Rear End, Etc.)
Location of Accident
Number of Fatalities
# of People Injured
Date of Accident
Nature of Accidents
Location of Accident
Number of Fatalities
# of People Injured
Date of Accident
Nature of Accidents
Location of Accident
Number of Fatalities
# of People Injured
Date of Accident
Nature of Accidents
Location of Accident
Number of Fatalities
# of People Injured
Additional Accident RecordsIf Needed
Upload

Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations):

Date
Location
Charge
Penalty
Date
Location
Charge
Penalty
Date
Location
Charge
Penalty
Date
Location
Charge
Penalty
Date
Location
Charge
Penalty
Driver’s License (list each driver’s license held in the past three(3) years:
State
License
Type
Endorsements
Exp. Date
State
License
Type
Endorsements
Exp. Date
State
License
Type
Endorsements
Exp. Date
State
License
Type
Endorsements
Exp. Date
State
License
Type
Endorsements
Exp. 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?
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)?
Have you ever been convicted of a felony?
Please Provide Details
0 /
Job References
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone
To Be Read and Signed by Applicant:

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

 

It is agreed and understood that the motor carrier or his agents mayinvestigate the applicant’s background to obtain any and all information ofconcern to applicant’s record, whether same is of record or not, and applicantreleases employers and person named herein from all liability for any damageson account of his furnishing such information.

 

It is also agreed and understood that under the Fair Credit ReportingAct, Public Law 91-508, I have been told that this investigation may include aninvestigating Consumer Report, including information regarding my character,general reputation, personal characteristics, and mode of living.

 

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

 

It is agreed and understood that this Application in no way obligatesthe motor carrier to employ or hire the applicant.

 

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

 

This certifies that this application was completed by me, and that allentries on it and information in it are true and complete to the best of myknowledge.

Applicant Signature
Date
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