A copy of your Driver's Record will be requested from the state in which your driver's license has been issued. If the violations and accidents listed on the application do not agree with your Driver's Record it will be grounds for rejection/disqualification.
Please select the following to determine what you are applying for: -Select- CD Company Driver IC Independent Contractor ICD Driver for IC *Required
Have you ever worked for this company before? -Select- YES NO *Required When?
Have you previously applied for Employement with this firm? -Select- Select Yes No *Required When?
Do you have a Hazmat Certification? Select Yes No
1. Have you ever been convicted of a felony?* -Select- Select Yes No **Conviction will not necessarily disqualify applicant from employment/contract.
2. If yes, will this conviction prohibit you from operating outside the continental United States? -Select- Select Yes No
3. Have you ever been known by any other name than the one on this application/qualification?* -Select- Select Yes No
4. Have you ever been discharged or suspended for any cause from a job?* -Select- Select Yes No When and Why
1. Did you ever have a "DUI" (Driving Under The Influence of Alcohol or Drugs)?* -Select- Select Yes No
2. How many accidents have you been in over the past 3 years *
3. How many driving violations have you had in the past 3 years?*
4. Has your license ever been suspended?* -Select- Select Yes No
5. Have you ever been convicted of a felony, the commission of which involved the use of a motor vehicle? -Select- Select Yes No * 6. Have you ever been convicted of a Reckless Driving Charge?* -Select- Select Yes No
7. Have you ever been denied a license, permit or privilege to operate a motor vehicle? * -Select- Select Yes No
8. Have you ever been convicted of leaving the scene of an accident which resulted in personal injury or death? -Select- Select Yes No
9. Have you ever been convicted of a crime involving manufacturing, knowing transportation, knowing possession, sale, or habitual use of amphetamine, or a derivative of a narcotic drug? -Select- Select Yes No
If the answer to any of the above is YES or greater than 0 State Circumstances and Dates in the Comment field: *120 words or less.
1. How many years of Over-the-Road Experience do you have?*
2. How many months of Over-the-Road Experience do you have in the past 3 years?*
3. Will you work as a Team Member?* -Select- Select Yes No
Begin with your present or most recent job and work backward in order, listing your employers/contracts for at least three years including all full time or part time employment. All time must be accounted for, including military service, self employment. Periods of unemployment must be explained to verify work history.
Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era and Section 503 of the Rehabiliation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accomodation to enable you to peform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
If you wish to be indentified, please select a choice in the dropdown list below:
-Select- Handicapped Individual Disabled Veteran Vietnam Era Veteran
If you spoke with a recruiter, please select their name: -Select- Terry Cox Jennifer Hardy Travis Montgomery Rhonda Yost
ACKNOWLEDGEMENT, AGREEMENT & RELEASE
I understand that as a condition of hire I must give the Company written authorization to obtain the results of all DOT required drug and/or alcohol tests (including any refusals to be tested) from all the companies for which I worked as a driver or which I took a pre-employment drug and/or alcohol test, during the past three (3) years. I have also been advised and understand that my signing of this authorization does not guarantee me a job or guarantee that I will be offered a position with the Company. In the aforementioned paragraphs, I have listed all of the companies for which I worked as a driver the past three (3) years, I hereby authorize the Company to obtain from these companies, and I hereby authorize those companies to furnish to Company, the follow information concerning my drug and alcohol tests: (i) all positive drug test results during the past (3) years: (ii) all alcohol test result of 0.04 or greater during the past (3) years: (iii)all alcohol test results of 0.02 or greater but less than 0.04 during the past three (3) years: (iv) all instances in which I refused, to submit to a DOT required drug and/or alcohol test during the past three (3) years.
TO BE READ AND ACKNOWLEDGED
Under the due process rights, the applicant has the right to review information provided by previous employers; the right to have errors in information corrected by the previous employer, and for that previous employer to re-send the corrected information to the prospective employers; and the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the applicant cannot agree on the accuracy of information. It is understood that the information in this application will be used and that prior employers will be contacted for the purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations. It is agreed and understood that the employer of his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishings such information. It is agreed and understood that if hired, the employee may be on a probationary period during which time he may be discharged without recourse. The applicant agrees to furnish such additional information and complete such examinations as maybe required to complete his employment file. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant. It is understood that the applicant, by presenting the application for employment represents that the statements given by the applicant to the information requested in this application are true, correct and complete,and that any false, misleading or incomplete statement of the information requested in the application shall be sufficient grounds for discharge from employment, regardless of the lapse of time. By submitting this application, I certify this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. It is understood that all applicants will be required to pass a DOT physical and any and all drug and alcohol tests.
I have carefully read and fully understand this authorization to release my past drug and alcohol test results and I have fully read and understand the due process rights listed above. I understand that I have a continuing obligation to furnish such additional information as maybe required to complete my employment file. In signing below, I certify that all of the information which I have furnished on this form is true and complete, and that I have identified all of the companies for which I have worked as a driver, or, to which I applied for work as a driver, during the past three years. By checking the Accept Box, you accept all of the terms and conditions of this agreement as of the date you checked such button. If you do not agree to all of these terms and conditions, you should not check the accept button. If you do not check the accept button you will not be able to submit your driver application.
Accept:
Southern Pines Trucking,Inc is an Equal Opportunity Employer