Driver Application DRIVER’S APPLICATION FOR EMPLOYMENT In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. TO BE READ AND SIGNED BY APPLICANT 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 dafter 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 Olson Carriers, Inc. 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 I have the fight 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 signature keyboard Clear Date Answer all questions. Please, print. If the answer to any questions is “No” or “None”, do not leave the item blank, but write “No” or “None”. Applicant Full Name Position Applying for Type Full-time Part-time Date of Application Date Available to start Date of birth Social Security No. E-mail Address Cell Phone No. Cell Service Carrier Emergency Phone No. Emergency Contact Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company before? Yes No If yes, when? Reason for leaving Are you employed now? Yes No How did you hear about Olson Carriers? 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)? For example, “climbing inside a trailer to sweep out”. If yes, explain if you wish List your addresses of residency for the past 3 years. Current Address Street Street City City State State Zip Code Zip Code How long? yr./mo. Previous Address Street Street City City State State Zip Code Zip Code How long? yr./mo. Street Street City City State State Zip Code Zip Code How long? yr./mo. Street Street City City State State Zip Code Zip Code How long? yr./mo. EMPLOYMENT HISTORY All driver applicants 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 shall also provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle (Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding). (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.) EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. RESPONSIBILITIES WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? Yes No 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 No MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. RESPONSIBILITIES WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? Yes No 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 No MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. RESPONSIBILITIES WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? Yes No 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 No MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. RESPONSIBILITIES WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? Yes No 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 No MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. RESPONSIBILITIES WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED? Yes No 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 No MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS If you are human, leave this field blank. Submit
