Careers

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 after 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 inter-view(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
    I understand that information 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 (c). I understand that I have the right 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.

    FOR COMPANY USE

    PROCESS RECORD

    TERMINATION OF EMPLOYMENT

    This form is made available with the understanding that J. J. Keller & Associates, Inc. is not engaged in rendering legal, accounting, or other professional services.
    J. J. Keller & Associates, Inc. assumes no responsibility for the use of this form, or any decision made by an employer which may violate local, state, or federal law.

    APPLICANT TO COMPLETE

    List your addresses of residency for the past 3 years.

    CURRENT ADDRESS

    PREVIOUS ADDRESS

    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 addi- tional 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.)

    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?

    EMPLOYMENT HISTORY (CONTINUED)

    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?
    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?
    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?
    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?
    WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED?
    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?

    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.
    The Federal Motor Carrier Safety Regulations (FMCSRS) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

    ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE

    Last Accident

    Next Previous

    Next Previous

    TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE
    EXPERIENCE AND QUALIFICATIONS – DRIVER
    Driver licenses or permits held in the past 3 years
    Driver licenses or permits held in the past 3 years
    Driver licenses or permits held in the past 3 years
    Driver licenses or permits held in the past 3 years
    A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
    B. Has any license, permit or privilege ever been suspended or revoked?
    DRIVING EXPERIENCE CHECK YES OR NO
    Class Of Equipment

    Straight Truck

    Class Of Equipment

    Tractor And Semi-Trailer

    Class Of Equipment

    Tractor-Two Trailer

    Class Of Equipment

    Tractor-Three Trailers

    Class Of Equipment

    Motorcoach-School Bus More Than 8 Passengers

    Motorcoach-School Bus More Than 15 Passengers

    EXPERIENCE AND QUALIFICATIONS – OTHER
    EDUCATION

    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.

    Please download and print the blank application. Once completed, applicants can submitted via email to cskiver@blakemanpropane.com or fax at 307-756-9614.
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