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Driver Employment Application
Driver Employment Application
Wil Coughlin
2020-03-03T15:23:16-05:00
Driver Application
Tucker Door & Trim is an equal opportunity employer and does not discriminate in hiring or employment based on race, color, religious creed, national origin, age, sex, marital status, physical or mental handicap, or veteran status. All statements on this application will be verified. Any misrepresentation or omission may be grounds for disqualification for employment consideration or continued employment. Fill in all items thoroughly.
Personal Information
Last Name
*
First Name
*
Middle or Maiden Name
Primary Phone
*
Secondary Phone
Email
May we contact you via E-Mail?
YES
NO
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Available Start Date
*
MM slash DD slash YYYY
Are you legally eligible to work in the United States?
*
If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States.
Yes
No
How did you hear about us?
*
Employee Referral
Other
Please list the Employee who referred you or how you heard about us.
Have you ever been employed by Tucker Door & Trim?
*
YES
NO
If YES, when and where?
Do you have any relatives who are currently employed with Tucker Door & Trim?
*
YES
NO
If YES, please provide their name and relationship.
Have you been convicted of a felony within the past 7 years?
*
YES
NO
Driver's License Information
Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license.” I certify that I do not have more than one motor vehicle license, the information for which is listed above.
License #
*
Class:
*
State:
*
Expiration Date:
*
MM slash DD slash YYYY
Driving Experience
I have no driving experience in the last 3 years.
YES
Class of Equipment
Straight Truck
Type of Equipment
Van, Reefer, Tank, Flat
Dates
mm/yyyy to mm/yyyy
Approximate Number of Miles
Class of Equipment
Tractor & Semi-Trailer
Type of Equipment
Van, Reefer, Tank, Flat
Dates
mm/yyyy to mm/yyyy
Approximate Number of Miles
Class of Equipment
Tractor - Two Trailers
Type of Equipment
Van, Reefer, Tank, Flat
Dates
mm/yyyy to mm/yyyy
Approximate Number of Miles
Employment History
Most Recent Employment
Name of Organization
*
Start Date
*
MM slash DD slash YYYY
End Date
*
MM slash DD slash YYYY
Job Title
*
Address
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Phone (Optional)
Reason for Leaving
*
Hours worked per week
*
Were you subject to the FMCSRs** while employed?
YES
NO
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
NO
Pay $
*
Per
*
Other Employment
Name of Organization
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Job Title
Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Phone
Reason for Leaving
Hours worked per week
Were you subject to the FMCSRs** while employed?
YES
NO
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
NO
Pay $
Per
Other Employment 2
Name of Organization
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Job Title
Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Phone
Reason for Leaving
Hours worked per week
Were you subject to the FMCSRs** while employed?
YES
NO
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
NO
Pay $
Per
Describe any additional specialized training, apprenticeship, tools or skills.
Forklift equipment, and or any material handling equipment, computers or handhelds, etc.
State any additional information you feel may be helpful to us in considering your application.
Applicant's Certification and Agreement
I certify that the entries and statements made by me on this application are, to the best of my knowledge, true, complete, and correct. I understand that any misrepresentation or material omission of fact on this or any other document required by Tucker Door & Trim, if employed, may be considered as constituting grounds for disciplinary measures, including dismissal. I further understand that any offer of employment is subject to successful completion of a drug screen, and where necessary, other examinations and background investigations. Having applied for employment with Tucker Door & Trim, I do hereby agree and do give my consent that any person, firm, or organization listed herein is authorized to furnish Tucker Door & Trim with personal or reference material concerning my character, past employment, or any other information they so request and release them from any damages whatsoever for issuing same.
You may contact my present employer
*
YES
NO
Resume Upload
If you have a resume please attach here. Only word documents and PDF files will be allowed.
Drop files here or
Select files
Accepted file types: doc, docx, pdf, Max. file size: 256 MB, Max. files: 3.
Signature
*
Reset signature
Signature locked. Reset to sign again
Signature Date
*
MM slash DD slash YYYY
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