Driver Application For Employment

Last Name *

First Name *

Middle Name

SSN

Date Of Birth (MM/DD/YY)

(Drivers Only) (The U.S. Department of Transportation requires that driver applicants state their date of birth - 391.21(b) (2).)

Current Address *

City *

State *

Zip *

Other Addresses

List any other addresses at which you have resided during the past 3 years:

Address

City

State

Zip

From

Add Remove

Phone Number *

County Of Residence *

School District

Ohio Only

Position Applying For *

Employment Term *

Temporary

Part-Time

Full-Time

Are you applying as an employee or owner operator? *

Employee

Owner Operator

Who referred you?

Rate of Pay Expected

Have you worked for TLC EXPRESS, LLC before? *

Yes

Dates From

Date To

Position

Reason for Leaving

Names of Relatives Working for TLC EXPRESS, LLC

Are you currently employed?

Yes

If not, how long since leaving last employment?

Education

Highest Grade Completed *

College

Trade School

Last School Attended *

City *

State *

Driving School Attended *

City *

State *

General

Have you ever been bonded? *

Yes

Name of Bonding Company

Have you ever been convicted of a felony? *

Yes

If yes, please explain fully.

Conviction of a crime is not an automatic bar to employment, all circumstances will be considered.

Have you ever been convicted of/or have a pending DWI/DUI? *

Yes

If yes, when?

Are you authorized to work in the United States? *

Yes

Have you ever worked for TLC EXPRESS, LLC under another name?

Yes

If so, what name?

Employment Record

The U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July, 1987 driver’s applicants must also show commercial driver employment for the seven years immediately proceeding this three-year period. 391.21(b) (10), (11).

Start with the current or most recent position, including military experience.

Employers

Employer Name

Supervisor’s Name

Address

City

State

Zip

Telephone Number

Fax Number

Position Held

From

Rate Of Pay

Reason for Leaving

Add Remove

Driver Experience and Qualification

Driver licenses held in the past 3 years must be shown.

State

License Number

Type

Expiration Date

Add Remove

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

Yes

2. Has any license, permit or privilege ever been suspended or revoked

Yes

3. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

Yes

If you answered “Yes” to any of the above, give details. *

Driving Experience

Straight Truck

Types of Equipment

From

Approximate Miles

Tractor & Semi Trailer

Types of Equipment

From

Approximate Miles

Twin Trailers

Types of Equipment

From

Approximate Miles

Other

Types of Equipment

From

Approximate Miles

List states operated in during the last 5 years

List special courses or training that will help you as a driver

List safe driving awards held and who presented the awards

Accident Review for Past 3 Years

Dates (Most Recent First)

Nature of Accident (Head-On, Rear-End, Upset, etc.)

Fatalities

Injuries

Add Remove

Traffic Convictions and Forfeitures for the Past 3 Years Other than Parking Violations

Location

Date

Charge

Penalty

Add Remove

Drug and Alcohol Testing

Pursuant to changes effective August 1, 2001, in Part 40 of the Federal Motor Carrier Safety Regulations, this section is being added to the driver application and should be completed by each applicant. These changes require each motor carrier to inquire of prospective drivers the information in the question below.

Have you, the applicant, had a positive alcohol or drug test result or refused to take a DOT drug or alcohol pre-employment test within the past three years from a motor carrier who did not hire you?

Yes

Name of Motor Carrier

Address

City

State

Zip

Phone Number

In addition, if the answer to the above question was “Yes”, please list the name and contact information for the Substance Abuse Professional (SAP) who completed your evaluation.

Name of SAP

Address

City

State

Zip

Phone Number

Other comments that you would like to add that you think would help in our decision

Applicant must read and sign.

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or its agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not. I hereby release TLC EXPRESS, LLC, its officers, employees, agents, directors, affiliates and attorneys and any other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508; I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics and mode.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation of omission of information of facts may result in my rejection or dismissal. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant.

If hired, I agree to abide by all the results and policies of my employer.

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. This also certifies that I have received a copy of the job description and company policies and all questions have been answered to my satisfaction.

Applicant Signature *

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info@tlcexpress.net

800-789-6516