Name
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First Name
Last Name
Date of Birth
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MM
DD
YYYY
Email
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Phone
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(###)
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Current Home Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Any experience with the special needs population? If yes, please explain in detail.
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Shift Availability
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SELECT ALL THAT APPLY (if you are available all day, select all shifts)
We are in need of early morning drivers, so if you are available for the first shift with rides starting at 6am, you will be highly considered for a position.
Days Available
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Please select all days that you are available to work for Wheelin To Go LLC.
Please confirm the following:
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In the past 5 years, have you had any moving violations, including speeding tickets, accidents, DUI's or any other driving infractions?
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If the you answered yes to the question above, please describe the infractions in detail, including date, infraction type, and outcome if any.
Have you ever been convicted of a felony?
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A felony does not automatically deny you of a position, all candidates are reasonably considered.
If you answered yes to the question above, please describe the matters of the felony in detail.
I authorize you to make such investigations and inquireis of my personal, employment, financial or medial history and other related matters as may be necessary in arriving at an employmnet decision. (Generally, inquireis 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 personal 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 the Company. I understand that information I provide regbarding 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 that I have the right to: * Review informatioun provided by previous employers; * Have errors in the information corrected by previouse employers and for those previouse employers to re-send the corrected informatioun to the prospective employer; and * Have a rebuttal statement attached to the alleged erroneous informatioun, if the previous employer(s) and I cannnot agree on the accuracy of the information. By typing my name below, I understand and authorize these investigations.
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In compliane with Federal and State equal employment opportunities 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.
Driver's License Number
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Please list any and all address where you have resided within the last 3 years, along with how long you lived there..
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Do you have the legal right to work in the United States?
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Is there any reason you may not be able to perform the following job: Driving adult individuals with special needs. If yes, please explain below.
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EMPLOYMENT HISTORY- Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. List complete mailing address, street number, city, state and zip code. (NOTE: List employers in reverse order starting with the most recent.)
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Please list employer names, dates of employment, reasons for leaving, and a general contact number.
a. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
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b. Has any license, permit or privilege ever bee suspended or revoked?
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If you answered yes to a. or b. above, please describe in detail including reason, outcome, violation and date.
What is one thing that you believe makes you stand out from others who may be applying for this job?
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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.
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Today's Date
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MM
DD
YYYY
