PERSONAL DATA

Date of Birth

name

Social Security No.

Present Address

How long have you lived at this address

Telephone No.()

Previous Address

Date of Birth

Driver’s License #Expiration Date

Are you a citizen of the United States of America?YesNo

Are you a veteran of the U.S. Military service?YesNo

Job Applied For

Rate of Pay Expected $Per

Are you employed now?

If not, how long since leaving last employment:

Who referred you?

Have you ever been convicted of a felony?

List states operated in, for the last five (5) years

List special courses/training completed (PTD/DDC, HAZMAT, Etc)

List any Safe Driving Awards you hold and from whom

PERSONAL REFERENCES

(Not former employers or relatives)

Name & Address

Occupation

Phone Number

RECORD OF EDUCATION

Name

Course of Study

Years Attended

Last Year Completed

Did You Graduate

List Diplomaor Degree

Grade Average

High School

College

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an addional 7 years’ information on those employers for whom the applicant operated such vehicle. Note: List employers in reverse order starting with the most recent. Add another sheet as necessary

EMPLOYER

Name

Address

City

State

Zip

CONTACT PERSON

PHONE NUMBER

DATE

from

to

POSITION HELDSALARY/WAGEREASON FOR LEAVING

were you subject to the FMCSRS while employed? YesNo

was your job designared as a safety - sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CER part 401? YesNo

have you ever failed a drug or alcohol test YesNo

EMPLOYER

Name

Address

City

State

Zip

CONTACT PERSON

PHONE NUMBER

DATE

from

to

POSITION HELDSALARY/WAGEREASON FOR LEAVING

were you subject to the FMCSRS while employed? YesNo

was your job designared as a safety - sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CER part 401? YesNo

have you ever failed a drug or alcohol test YesNo

EMPLOYER

Name

Address

City

State

Zip

CONTACT PERSON

PHONE NUMBER

DATE

from

to

POSITION HELDSALARY/WAGEREASON FOR LEAVING

were you subject to the FMCSRS while employed? YesNo

was your job designared as a safety - sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CER part 401? YesNo

have you ever failed a drug or alcohol test YesNo

EMPLOYER

Name

Address

City

State

Zip

CONTACT PERSON

PHONE NUMBER

DATE

from

to

POSITION HELDSALARY/WAGEREASON FOR LEAVING

were you subject to the FMCSRS while employed? YesNo

was your job designared as a safety - sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CER part 401? YesNo

have you ever failed a drug or alcohol test YesNo

EMPLOYER

Name

Address

City

State

Zip

CONTACT PERSON

PHONE NUMBER

DATE

from

to

POSITION HELDSALARY/WAGEREASON FOR LEAVING

were you subject to the FMCSRS while employed? YesNo

was your job designared as a safety - sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CER part 401? YesNo

have you ever failed a drug or alcohol test YesNo

ACCIDENT RECORD

For the past three years or more(attach sheet if more sapce is needed) if none, write none.

DATES

NATURE OF ACCIDENT(head-on, rear-end, upset, etc)

Fatalities

injuries

HAZardous material spill

Last ACCIDENT

Next Previous

Traffic convictions

and forfeitures for the past three years (other than parking violations) If nonem write none.

Location(head-on, rear-end, upset, etc)

Date

Charge

penalty

Experience & QUALIFICATIONS

List all driver licenses or permits held in the past three years.

state

license no.

type

expiration date

LICENSE, PERMIT ETC.

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

Has any license, permit or privilege ever been suspended or revoked?
YesNo

If the answer is yes to either, give details:

DRIVING EXPERIENCE

Check YES or No.

CLASS OF EQUIPMENT

CIRCLE TYPE OF EQUIPMENT

DATES

APPROX. NO. OF MILES

STRAIGHT TRUCKYesNo

VAN, TANK, FLAT, DUMP,REFER, TOW TRUCK

TRACTOR AND SEMI-TRAILER YesNo

AN, TANK, FLAT, DUMP,REFER, TOW TRUCK

TRACTOR-TWO TRAILERS YesNo

VAN, TANK, FLAT, DUMP,REFER, TOW TRUCK

MOTORCOACH-SCHOOL BUS YesNo
more than 8 passengers

VAN, TANK, FLAT, DUMP,REFER, TOW TRUCK

MOTORCOACH-SCHOOL BUS YesNo
more than 15 passengers

VAN, TANK, FLAT, DUMP,REFER, TOW TRUCK

TOW TRUCK/ROLLBACK YesNo

VAN, TANK, FLAT, DUMP,REFER, TOW TRUCK

OTHER

IMPORTANT – PLEASE READ CAREFULLY BEFORE AGREEING TO TERMS

I certify that information given herein is true and complete to the best of my knowledge. I authorize investigation of all statements and references contained in this employment application as may be necessary in arriving at an employment decision, including requests for criminal, credit, or motor vehicle driving reports. I understand that incorrect, misleading or incomplete information on this application may result in immediate termination
of employment. I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave employment upon prior notice and may be terminated by the employer at any time and for any reason. I also understand that any oral or written statements to the contrary are expressly disavowed and should not be relied upon by any prospective or existing employee. I understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs during employment.

It is agreed that Elite Towing LLC & Skat Transport LLC

- will do a background check and drug test before job offer.

-will interview applicant twice before any job offer.

-could take up to two weeks to process the background check.

-has a 90 day probation period If any days are missed during this time, applicant will be dismissed.

-will deduct any damages done to any equipment due to neglect out of applicant’s pay.

By checking this box I agree to the above terms

COMMERCIAL DRIVER APPLICATION

PERSONAL DATA

PERSONAL REFERENCES

RECORD OF EDUCATION

EMPLOYMENT HISTORY

ACCIDENT RECORD

Traffic convictions

Experience & QUALIFICATIONS

LICENSE, PERMIT ETC.

DRIVING EXPERIENCE

IMPORTANT – PLEASE READ CAREFULLY BEFORE AGREEING TO TERMS