Driver's Employment Application

CDL Driver applicants can complete and submit the following online application.

NOTICE TO ALL TRUCK DRIVER APPLICANTS

YOU MUST PROVIDE THE FOLLOWING IN ORDER TO BE CONSIDERED FOR A POSITION WITH OUR COMPANY:

If you are a CDL holder and are applying for a driving position, prior to submitting this Employment Application you MUST register and create an account with the Federal Motor Carrier Safety Administration (FMCSA) Drug & Alcohol Clearinghouse. We cannot consider you for employment unit you have created this account.

Registration is available at:
clearinghouse.fmcsa.dot.gov/register
Application with previous employer’s complete address
Current copy of driving record and current physical card

If driving record is not submitted or application is incomplete, you will not be considered for a position!

For more information, visit clearinghouse.fmcsa.dot.gov

Position Applying For:

Name(Required)

First Middle Last

Social Security Number

Date of Birth(Required)

MM slash DD slash YYYY

Phone Number(Required)

Past 3 Years of Residency(Required)

Street

City

State

Zip Code

Number of years

Are you 18 years or older?(Required)

Yes

Legally eligible for employment in the U.S.:(Required)

Yes

Will you work overtime, emergency hours, Saturday or Sunday, if necessary?(Required)

Yes

Are you physically able to perform the duties of the job for which you are applying for?(Required)

Yes

Have you ever worked for this company before?(Required)

Yes

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Reason for leaving:

Do you have reliable transportation to work?(Required)

Yes

Education

Select the last year of school completed:

School Information

Name of School

City and State

Courses Taken

Have you served in the Armed Forces?(Required)

Yes

Branch

Rank

Discharged

Employment History

All applicants wishing to drive in interstate commerce must provide the following information on ALL employers during the preceding 3 years. Applicants to drive a commercial motor vehicle (GVWR of 26,001 lbs or more or any size vehicle used to transport hazardous materials in a quantity requiring placarding) shall provide an additional 7 years information on those employers for whom the applicant operated such vehicle. Any gaps in employment must be explained. List the complete mailing address: street number, city, state and zip code.

Last Employer(Required)

Phone(Required)

May we contact?(Required)

Yes

Address(Required)

Street Address Address Line 2 City State ZIP Code

Position Held:(Required)

Employed From(Required)

MM slash DD slash YYYY

Employed To

MM slash DD slash YYYY

Reason for leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?(Required)

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 size and is used to transport hazardous materials in a quantity requiring placarding.

Yes

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?(Required)

Yes

Second to Last Employer

Phone

May we contact?

Yes

Address

Street Address Address Line 2 City State ZIP Code

Position Held:(Required)

Employed from:

MM slash DD slash YYYY

Employed to:

MM slash DD slash YYYY

Reason for leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?(Required)

Yes

Was your job desingated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

Third to Last Employer

Phone

May we contact?

Yes

Address

Street Address Address Line 2 City State ZIP Code

Position Held:(Required)

Employed from:

MM slash DD slash YYYY

Employed to:

MM slash DD slash YYYY

Reason for leaving:

Employed from:

MM slash DD slash YYYY

Employed to:

MM slash DD slash YYYY

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?(Required)

Yes

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?(Required)

Yes

Fourth to Last Employer

Phone

May we contact?

Yes

Address

Street Address Address Line 2 City State ZIP Code

Position Held:

Employed from:

MM slash DD slash YYYY

Employed to:

MM slash DD slash YYYY

Reason for leaving:

Employed from:

MM slash DD slash YYYY

Employed to:

MM slash DD slash YYYY

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

Yes

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

Account for period between jobs (including dates and reasons):

Accident Record for Past 3 Years

List Accidents(Required)

Dates

Nature of Accident (head-on, rear-end, upset, etc.)

Fatalities

Injuries

Hazardous Material Spill

Traffic Convictions and Forfeitures for Past 3 Years

Other than parking violations

List traffic convictions and forfeitures(Required)

Location

Date

Charge

Penalty

Experience and Qualifications

List all driver licenses or permits held.

List experience/qualifications(Required)

State

License No.

Type

Expiration Date

Have you ever been denied a license, permit or privilege to operate a motor vehicle?(Required)

Yes

Has any license, permit or privilege ever been suspended or revoked?(Required)

Yes

IF THE ANSWER TO EITHER OF THE PREVIOUS 2 QUESTIONS IS YES, GIVE DETAILS(Required)

Driving Experience

Straight Truck(Required)

Yes

Select Truck Type(Required)

Van

Tank

Flat

Dump

From Date

MM slash DD slash YYYY

Straight truck

To Date

MM slash DD slash YYYY

Straight truck

Approximate Total Miles Driven

Straight truck

Tractor-Trailer(Required)

Yes

Select Tractor-Trailer type(Required)

Van

Tank

Flat

Dump

From Date

MM slash DD slash YYYY

Tractor-trailer

To Date

MM slash DD slash YYYY

Tractor-trailer

Approximate Total Miles Driven

Tractor-trailer

Bus(Required)

Yes

From Date

MM slash DD slash YYYY

Bus

To Date

MM slash DD slash YYYY

Bus

Approximate Total Miles Driven

Bus

Other Driving Experience

Class of Equipment

Type of Truck

Date From

Date To

Approxmiate Miles Driven

List states operated in for the last 5 years:

Which special training or courses have you taken:

References

Please list 3 persons not related to you.

Reference #1(Required)

Name

Phone

Relationship

Years known

Reference #2(Required)

Name

Phone

Relationship

Years known

Reference #3(Required)

Name

Phone

Relationship

Years known

How did you find out about this employment opportunity?(Required)

Newspaper

Perry Employee

VEC

Internal Applicant

Project Site Bulletin Board

List name of referring individual(Required)

I understand that the processing of my employment application requires the expenditure of time and resources by this employer. I understand that this application does not constitute a contract for employment. I also understand that this employer would not process this application if I had no genuine interest in employment at the time this application is submitted. Therefore, I hereby represent and certify that I am interested in employment with Perry Engineering, Inc., and that my application is submitted in good faith and genuine interest in employment. I hereby consent to a drug screening test. I understand and agree that any omission or falsification of this application may be cause for the disqualification of my application or termination of employment. I understand and agree that, once hired, I am required to abide by all rules and regulations of Perry Engineering, Inc

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

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 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.

Signature of Applicant(Required)

By signing, this certifies that this application was completed by me, and that all entries and information are true and complete to the best of my knowledge.

Date of Signature(Required)

MM slash DD slash YYYY

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

We consider all applicants for positions without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related mental or physical disability, or any other similarly protected status.

Perry Engineering Company Inc.

Perry Engineering Company Inc.

Driver's Employment Application

NOTICE TO ALL TRUCK DRIVER APPLICANTS

Education

Employment History

Accident Record for Past 3 Years

Traffic Convictions and Forfeitures for Past 3 Years

Experience and Qualifications

Driving Experience

References

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Contact

Fax Numbers