"*" indicates required fields

This is a driver qualification master form, please fill out the information below on this page.

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Company Name: Sojourner Trucking, Inc.

Company Address: 26113 Highway 27 South

City, State ZIP: Crystal Springs, MS 39059

Company Phone: 601-892-4456

Company Fax: 601-892-0558

Company DER: Ben Sojourner


Driver Information

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Sojourner Trucking, Inc.

26113 Highway 27 South

Crystal Springs, MS 39059

Driver Application for Employment

Applicant Information

Print all information in blue or black ink only. All information must be filled out. If information is not applicable to you, please write none. Only completed applications will be accepted.

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Applicants Full Name*

Phone numbers

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List your address(es) of residency for the past three years:

Previous Address:

Previous Address:

Do you have the legal right to work in the United States?*

(please be prepared to supply supporting documentation)

Are you currently employed?*
May we contact your present employer?*
Is there any reason you might be unable to perform the functions of the job for which you have applied as described in the attached job description?*

Education

Please select the highest grade completed

Elementary
High School
College

Last school attended:

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three years. Applicants to drive a commercial motor vehicle* in interstate or intrastate commerce shall also provide an additional seven years information on those employers for whom the applicant operated such vehicle. Print all information and complete all sections. Complete mailing addresses, street number, city, state, zip code and phone number are required.

List employers in reverse order starting with the most recent, or current, employer. Add additional sheets if necessary.

Employer:

Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?*
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?*
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?

Employment History (continued)

Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?
Were you subject to the Federal Motor Carrier Safety Regulations while with this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the alcohol and controlled substance requirements of 49 CFR Part 40?

Qualifications

List information regarding your driving experience for the last five years. If no driving experience, write none.

Driver’s License(s) – list each license held in the previous three (3) years*
State of Licensure
License Number
Type of License
Expiration date
 
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
Has any license, permit, or privilege ever been suspended or revoked?*
List any special courses, training or awards which may pertain to the job for which you are applying:*
Description
Received by
Date
 

Driver Experience

List information regarding your driving experience for the last five years. If no driving experience, write none.

Class of Equipment

Straight Truck

Tractor and Semi-Trailer

Motorcoach/Bus

Other

Traffic Convictions and Forfeitures

List all traffic convictions and forfeitures for the past three (3) years. Do not include parking violations.

List all traffic convictions and forfeitures for the past three (3) years. Do not include parking violations.*
Location
Date
Charge
Penalty
 

Accident History

Federal Motor Carrier Safety Regulations require that all potential employees applying for a position to drive a motor vehicle furnish a list of all motor vehicle accidents in which the applicant was involved during the three (3) years preceding the date the application is submitted, specifying the date and nature of each accident and any fatalities or personal injuries it caused. (FMCSR, April 1, 2007 391.21 (b) (7))

List all traffic convictions and forfeitures for the past three (3) years. Do not include parking violations.*
Date of accident
Nature of accident
Fatalities
Injuries
 

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to inquire of personal, employment, financial, medical and other related matters as may be necessary at arriving at employment decisions. I hereby release employers, schools, health care providers and other personnel from all liability in response to and release of information regarding my application. In the event of employment, I understand that false and/or misleading information given in my application or interview may result in discharge. I understand that I am required to abide by all rules and regulations of the company for which I am applying. I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49CFR391.23(d) and (e). I also understand I have the following rights: (1) Review of information provided by previous employers (2) Have errors in such information corrected and resent by previous employers to the prospective employer (3) Have a rebuttal statement attached to the alleged erroneous information if previous employer and I cannot agree on the accuracy of the information.

Please type your name below and check the box below to confirm that you have read and understand the above requirements.*
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