CDL Application

Commercial Driver Employment Application

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment services and programs is available to all persons. Those applicants requiring reasonable accommodation for the application and/or interview process should notify a representative of the organization.

"*" indicates required fields

Date*

Applicant Name*

First Middle Last

Phone*

Date of Birth*

Position Applied For*

Desired Salary*

Email*

Date you will be able to start work*

Current/Previous Addresses

Current Address*

Street Address Address Line 2 City State ZIP Code

Dates at Address

Example: 02/14 - 08/21

Previous Address

Street Address Address Line 2 City State ZIP Code

Dates at Address

Example: 02/14 - 08/21

Previous Address

Street Address Address Line 2 City State ZIP Code

Dates at Address

Example: 02/14 - 08/21

Applicant Questions

Type of employment desired*

Full-time

Part-time

Temporary

Will you be able to meet the attendance requirements?

Yes

Do you have any objection to working overtime if necessary?

Yes

Can you travel if required by this position?

Yes

Have you ever been previously employed by our organization?

Yes

Can you submit proof of legal employment authorization and identity?*

Yes

Have you ever been convicted of a crime in the last 7 years?*

Yes

If yes, please explain (a conviction will not automatically bar employment)

How were you referred to us?

Driving Credintials

Licenses*

No person who operates a commercial motor vehicle shall have more than one driver's license (Zl9CFR 383 21) I CERTIFY THAT I DO NOT HAVE MORE THAN ONE MOTOR VEHICLE LICENSE, THE INFORMATION FOR WHICH IS LISTED BELOW Include all licenses held for the past 3 years.

State

License #

Type/Class

Endorsements

Class of Equipment*

Example: Class of Equipment: Straight Truck - Type of Equipment: Flat

Class of Equipment

Type of Equipment

Moving Violations (Previous 3 Years)*

List most recent first. If there are none please write a "-" in each field the first line.

Date

Violation

State of Violation

Penalty (revocation, points and/or collateral)

Date Convicted (MM/YY)

Accident History (Previous 3 years)*

List most recent first. If there are none please write a "-" in each field the first line.

Date

Nature of Crash

No. of Injuries

Fatalities

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

Yes

If yes, please explain*

Has any license, permit, or privilege to drive been suspended or revoked?*

Yes

If yes, please explain*

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position including any military experience. and work backwards (email separate sheets, if necessary). You are required to list the complete mailing address, including street number. city, state, zip and complete all other information.

Current (or Most Recent) Employer

Employer Name*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Supervisor Name*

Contact Number*

Employment Start Date*

End Date*

Position Held*

Salary*

Please also include if the total is Annual, Weekly, Hourly, or some other timeframe.

Reason for leaving*

While employed here were you subject to Federal Motor Carrier Regulations?*

Yes

Was the job designated as a safety sensitive function in any Department of Transportation regulated mode, subject to alcohol and controlled substance testing as required by 49 CFR, part 40?*

Yes

Second-Most Recent Employer

Employer Name*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Supervisor Name*

Contact Number*

Employment Start Date*

End Date*

Position Held*

Salary*

Please also include if the total is Annual, Weekly, Hourly, or some other timeframe.

Reason for leaving*

While employed here were you subject to Federal Motor Carrier Regulations?*

Yes

Was the job designated as a safety sensitive function in any Department of Transportation regulated mode, subject to alcohol and controlled substance testing as required by 49 CFR, part 40?*

Yes

Third-Most Recent Employer

Employer Name*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Supervisor Name*

Contact Number*

Employment Start Date*

End Date*

Position Held*

Salary*

Please also include if the total is Annual, Weekly, Hourly, or some other timeframe.

Reason for leaving*

While employed here were you subject to Federal Motor Carrier Regulations?*

Yes

Was the job designated as a safety sensitive function in any Department of Transportation regulated mode, subject to alcohol and controlled substance testing as required by 49 CFR, part 40?*

Yes

If you have additional employers please email them to(jwilliams@shoosmith.com)

Employment Gaps

Please explain any gaps in employment (Include month/year & reason)

Start Date (Month/Year)

End Date (Month/Year)

Reason

Other skills and qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.

Educational History

List school name and location, years completed, course of study, and any degrees earned.

High school

College

Technical Training

Other

References

List 3 reference names, telephone numbers, and years known (do not include relatives or employers)

Reference name

Reference phone number

Years known

Reference name

Reference phone number

Years known

Reference name

Reference phone number

Years known

Authorization and Employment Acknowledgment Statement

I hereby authorize Shoosmith Construction, Inc. to contact, obtain, and verify the accuracy of information contained in this application from current & previous employers, educational institutions, and references. I also hereby release Shoosmith Construction, Inc. and its representatives from liability for seeking, gathering, and using such information to make employment decisions and I release all other organization from any liability for providing such information.

I understand that any misrepresentation or material omission made on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, wherever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and this application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate the relationship at will, with or without cause at any time, so long as there is no violation of applicable state or federal law.

I understand that it is the policy of this organization not to refuse employment or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I also understand that the information I provide regarding my current 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 CFR391.23. I understand that I have the right to:

• Review information provided by current/previous employer
• Have errors in information corrected by previous employers, and for those employers to resend 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.

This certifies that I completed this application, and that all entries herein are true and complete to the best of my knowledge. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment with Shoosmith Construction, Inc. under these conditions.

Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Terms and conditions*

I represent and warrant that I have read and fully understand the foregoing, and that i seek employment under these conditions.

Name

This field is for validation purposes and should be left unchanged.