ELLE
Name
Current Address
City, State/Province
Zip/Postal
Country
Jorge A Escobar
Riverside, CA 92509
United States
What position are you
applying for?
Are you 21 or older?
Do you have a Class A
CDL?
How many months of
Class A CDL experience
do you have?
What location are you
applying for?
Are you legally eligible for
employment in the United
States?
Are you currently
employed?
What date did your last
employment end?
Do you read, write, and
speak English?
What is your preferred
pronoun?
Have you ever worked for
this company before?
Enter start and end dates,
location, position, and
reason for leaving:
Do you have a current
TWIC card?
Expiration date:
Have you ever been known
by any other name?
Enter name:
How did you hear about
us?
If "Driver Referral’, please
enter the driver's name
If "Other", please explain
Can you pass a DOT drug
test?
Incase of Emergency,
notify (list name, address,
and phone):
Residence 3 years or Yes
longer (If No, previous
addresses shown below)
SSN/SIN ***-**-****
Date of Birth 11-04-1983
Primary Phone 951-***-****
Preferred method of Primary Phone
contact
Best time to contact you Any
Email *********@*****.***
Company Questions
GENERAL INFORMATION
Company Driver
Yes
More than 3 months
experience
Rialto ca
Yes
Yes
No
No
No
Web
Yes
Rubi adame
2947 heller dr
Riveeside ca
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment
(van, reefer, tank, etc.), start and end dates, and
approximate number of total miles. If no experience in a
class, enter "NONE".
Straight Truck
Tractor and Semi-Trailer
Tractor - Two Trailers
Other
Which safe driving awards
do you hold and from
whom?
lagree to C.R. England's
Privacy Policy.
9-10 years
9-10 years
Less than 1 year
Roll off trucks
pay
Please provide all licenses you have held within the last
3 years.
License Number 01888378
Licensing Authority CA
Country US
License Class Class A
License Expiration Date 11-04-2028
DOT Medical Card 05-20-2026
Expiration Date
Current License Yes
Commercial Driver Yes
License
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement Yes
Hazmat Expiration Date 11-04-2028
X Endorsement Yes
Doubles Triples Yes
Endorsement
Other Endorsement No
Artesia sawdust
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Were you
terminated/discharged/laid
off?
Is this your current
employer?
May we contact this
employer at this time?
Did you operate a
commercial motor vehicle?
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job, regulated by DOT, and
subject to drug and alcohol
testing?
Areas Driven
Miles driven weekly
Most common truck
driven
Most common trailer
Trailer length
Unemployment
Start Date
End Date
Comment
Harper precast
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Were you
terminated/discharged/laid
off?
Termination Explanation
Is this your current
employer?
May we contact this
employer at this time?
Did you operate a
commercial motor vehicle?
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job subject to drug and
alcohol testing?
Areas Driven
Miles driven weekly
Most common truck
driven
Most common trailer
Trailer length
Arias n sons
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Were you
terminated/discharged/laid
off?
Is this your current
employer?
May we contact this
employer at this time?
Did you operate a
commercial motor vehicle?
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job, regulated by DOT, and
subject to drug and alcohol
testing?
Areas Driven
Miles driven weekly
Most common truck
driven
Most common trailer
Trailer length
Employment / Unemployment
Artesia sawdust
06-2024
10-2024
Ontario, CA
United States
Current employer
No
Yes
Yes
Yes
Yes
Yes
Class B Vehicle
Container
31 feet or less
03-2020
09-2023
Unemployed
Harper precast
01-2017
03-2020
Corona, CA
United States
Lack of work
Yes
Lack of work
No
Yes
No
Arias n sons
01-2014
08-2017
Norco, CA
United States
Move to harper
No
No
Yes
Yes
No
Yes
500-1000
Dump Truck
Other
31 feet or less
Under FMCSR 391.15, are
you currently disqualified
from driving a commercial
motor vehicle? [49 CFR
391.15]
Has your license, permit or
privilege to drive ever been
suspended or revoked for
any reason? [49 CFR
391.21(b)(9)]
Have you ever been denied
a license, permit, or
privilege to operate a
motor vehicle?[49 CFR
391.21(b)(9)]
Within the past two years,
have you tested positive,
or refused to test, on a pre-
employment drug or
alcohol test by an
employer to whom you
applied, but did not obtain,
safety-sensitive
transportation work
covered by DOT agency
drug and alcohol testing
rules? [49 CFR 40.25 ]
In the past three(3) years,
have you ever been
convicted of any of the
following offenses: [49
CFR 391.15]:
+ Drivinga
commercial motor
vehicle with a
blood alcohol
concentration
("BAC’) of .04
percent or more
Driving under the
influence of
alcohol, as
prescribed by state
law
Refusal to undergo
drug and alcohol
testing as required
by any jurisdiction
for the
enforcement of
Federal Motor
Carrier Safety Act
regulations
Driving a
commercial motor
vehicle under the
influence of any 21
C.FR. 1308.11
Schedule
identified
controlled
substance, an
amphetamine, a
narcotic drug, a
formulation of an
amphetamine, or a
derivative of a
narcotic drug
Transportation,
possession, or
unlawful use of a
21 C.FR. 1308.11
Schedule
identified
controlled
substance,
amphetamines,
narcotic drugs,
formulations of an
amphetamine, or
derivatives of
narcotic drugs
while you were on
duty driving for a
motor carrier
Leaving the scene
of an accident
while operating a
commercial motor
vehicle
Or any other felony
involving the use
of a commercial
motor vehicle
FMCSR
No
No.
No.
No.
No
Cif CP Neto al a Crete fe]
Were you involved in any accidents/incidents with any
vehicle in the last 5 years (even if not at fault)?
No Accidents
BIC URAL
Have you had any moving violations or traffic
convictions in the past 3 years?
No Violations