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TO BE READ AND SIGNED BY APPLICANT

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 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by 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.

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Date
Month
Day
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Can you perform, with or without reasonable accommodation, the essential functions of the job (as described in the attached job description)?
Yes
No
DO YOU UNDERSTAND THAT YOU MUST COMPLETE PART 2 OF THIS APPLICATION TO COMPLETE THE APPLICATION PROCESS?
YES
NO

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following informaiton on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code.


Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

DATE EMPLOYED FROM:
Month
Day
Year
TO:
Month
Day
Year
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
DATE EMPLOYED FROM:
Month
Day
Year
TO:
Month
Day
Year
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
DATE EMPLOYED FROM:
Month
Day
Year
TO:
Month
Day
Year
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

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 lbs. or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any sizde and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE.

IF NONE, WRITE NONE.

 (UPLOAD ADDITIONAL INFORMATION IF NEEDED AT THE BOTTOM OF PART 3 OF THIS APPLICATION).

I understand that there is a Part 1, 2, and 3 to complete this application and I must complete all parts of the application to be considered
YES
NO

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS). IF NONE, WRITE NONE.

MORE INFORMATION CAN BE UPLOADED AT THE BOTTOM OF THIS PAGE.

EXPERIENCE AND QUALIFICATIONS - DRIVER

Driver licenses or permits held in the past 3 years:

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Has any license, permit or privilege ever been suspended or revoked?
Yes
No

DRIVING EXPERIENCE - CLASS OF EQUIPMENT

PLEASE SELECT ALL THAT APPLY

Education

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it (Application Parts 1-3) and information in it are true and complete to the best of my knowledge.

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Date
Month
Day
Year
I understand that there is a Part 1, 2, and 3 to complete this application and I must complete all parts of the application to be considered
Yes
No

1(417) 532-0815

WEOTrucksLLC@Yahoo.com

15118 Edison Rd, Lebanon, MO 65536, USA

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