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Career Opportunities: CDL B Local Delivery Driver - Full Time & Seasonal Opportunities!

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CDL B Local Delivery Driver - Full Time & Seasonal Opportunities! (20572)

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Job-Specific Information

Company Name

Location: Region/District/Branch

Company Address:

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 current/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.

Type Name Here – to serve as electronic signature

Date of Signature

Address History:

List Your Previous Address(es) of Residency for the Past 3 Years If Different From Current. If you do not have enough room to cover the full three years, we will collect the remaining information at a later date.

Address 1

Address 2

City

State

One or more results are available, use up and down arrow keys to navigate.

Zip

Number of Years

Address 1

Address 2

City

State

Zip

Number of Years

Address 1

Address 2

City

State

Zip

Number of Years

Previous Employment and/or Training:

PLEASE NOTE: You must account for a FULL 10 year history with NO GAPS; this is required under federal DOT regulations. Employment, unemployment or educational periods can be used in your form to account for your 10 year history. Please fill out this section completely, start with your most recent (or present) position first. If you do not have enough room to cover the full 10 years, we will collect the remaining information at a later date.

Employer Name, Address, and Phone Number

Employer Name, Address, and Phone Number

Answer size should be 1024 characters or less.

Position Held

Reason for Leaving

Ok to contact this employer?

One or more results are available, use up and down arrow keys to navigate.

Start Date

End Date

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

One or more results are available, use up and down arrow keys to navigate.

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?

One or more results are available, use up and down arrow keys to navigate.

Employer Name, Address, and Phone Number

Employer Name, Address, and Phone Number

Answer size should be 1024 characters or less.

Position Held

Reason for Leaving

Ok to contact this employer?

One or more results are available, use up and down arrow keys to navigate.

Start Date

End Date

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

One or more results are available, use up and down arrow keys to navigate.

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?

One or more results are available, use up and down arrow keys to navigate.

Employer Name, Address, and Phone Number

Employer Name, Address, and Phone Number

Answer size should be 1024 characters or less.

Position Held

Reason for Leaving

Ok to contact this employer?

One or more results are available, use up and down arrow keys to navigate.

Start Date

End Date

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

One or more results are available, use up and down arrow keys to navigate.

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?

One or more results are available, use up and down arrow keys to navigate.

Employer Name, Address, and Phone Number

Employer Name, Address, and Phone Number

Answer size should be 1024 characters or less.

Position Held

Reason for Leaving

Ok to contact this employer?

Start Date

End Date

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

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, Address, and Phone Number

Employer Name, Address, and Phone Number

Answer size should be 1024 characters or less.

Position Held

Reason for Leaving

Ok to contact this employer?

Start Date

End Date

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

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?

Drivers License Information:

* Driver's License Number

* License Expiration Date

* Driver's License State

* Class

* Have you ever been denied a license, permit, or privilege to operate a motor vehicle? If yes, please enter comments in the next box.

If Yes, please provide comments

* Has any license, permit, or privilege ever been suspended or revoked? If yes, please enter comments in the next box.

If Yes, please provide comments

Endorsments: check the ones that are relevant.

H Authorizes the transportation of <strong>hazardous material</strong> (CDL only)

H Authorizes the transportation of <strong>hazardous material</strong> (CDL only)

N Authorizes the operation of tank vehicle (CDL or CLP only)

N Authorizes the operation of tank vehicle (CDL or CLP only)

P Authorizes the operation of a vehicle transporting passengers (CDL or CLP only)

P Authorizes the operation of a vehicle transporting passengers (CDL or CLP only)

S Authorizes the operation of a school bus< (CDL or CLP only)

S Authorizes the operation of a school bus< (CDL or CLP only)

T Authorizes towing two (double) or three (triple) trailers over specified weight

T Authorizes towing two (double) or three (triple) trailers over specified weight

X Authorizes the operation of compbination of hazardous material and tank vehicle (CDL only)

X Authorizes the operation of compbination of hazardous material and tank vehicle (CDL only)

Driving Experience:

If you have No Experience, enter today's date in the From and To dates that come next.

* Class of Equipment

If you selected Other in the previous question, please specify.

Type of Equipment

* From

* To

* Approximate number of Miles

Class of Equipment

If you selected Other in the previous question, please specify.

From

To

Approximate number of Miles

Class of Equipment

If you selected Other in the previous question, please specify.

From

To

Approximate number of Miles

Annual Review of Driving Record:

Name of Driver

ID Number

Motor Carrier - Name and Address

INSTRUCTIONS TO CARRIER: At least once every 12 months, obtain the motor vehicle record (MVR) of each driver, covering at least the preceding 12 months, from each driver’s licensing authority where the driver held a commercial motor vehicle operator’s license or permit during that time period.

Review the MVR in accordance with 49 CFR §391.25, as outlined below, and complete the Certificate of Review.

The purpose of the review is to determine whether the driver meets minimum requirements for safe driving or is disqualified to drive a motor vehicle pursuant to §391.15 or (for CDL holders) §383.51. When reviewing the MVR, consider any evidence that the driver has violated applicable provisions of the Federal Motor Carrier Safety Regulations or Hazardous Materials Regulations. Also consider the driver’s accident record and any evidence that the driver has violated laws governing the operation of motor vehicles. Motor carriers must give great weight to violations — such as speeding, reckless driving, or operating while under the influence of alcohol or drugs — that indicate that the driver has exhibited a disregard for public safety.

CERTIFICATE OF REVIEW I hereby certify that I have reviewed the driving record of the above-named driver in accordance with 49 CFR §391.25 and find that the driver (check one):

Required Declarations:

Accident History (3 years).

* Have you had an accident during the past 3 years? If yes, please enter comments in the next box.

* Comments (Please enter month, year, and a brief description. If none, enter N/A.)

Comments (Please enter month, year, and a brief description. If none, enter N/A.)

Answer size should be 1024 characters or less.

Number of fatalities

Number of Injuries

Hazardous Materials Spill

Traffic Convictions and Forfeitures (3 years).

* Have you had any traffic convictions and forfeitures over the past 3 years (other than parking violations)? If yes, please enter comments in the next box.

* Comments (Please enter month, year, and a brief description. If none, enter N/A.)

Comments (Please enter month, year, and a brief description. If none, enter N/A.)

Answer size should be 1024 characters or less.

Violation (other than violations involving parking only.)

Penalty

* Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?

* If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?

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.

* Type Name Here – to serve as electronic signature

* Date of Signature

* Date of Birth

* Social Security Number

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