Application for Employment  
 
  Applicants are considered without regard to race, creed, color, sex, religion, age, national origin, or disability.  
 
You must choose an option below to complete the application.
Applying For: Driver / CDL Maintenance Maintenance
with CDL
 
Personal Information
Name:
  (First) (Middle) (Last)
Phone: (ex. 419-332-5111) Social Security Number:
(ex. 123-123-1234)
D.O.B. (ex. 01/01/1970) Have you worked for us before? Yes No
  Date of Previous employment:
(ex. 01/01/1970)
 
Current Address
Address: County:
City: State:
Zip Code: How long have you lived here? (Years)
 
Previous Address
Address: County:
City: State:
Zip Code: How long had you lived there? (Years)
 

Employment History (Past 10 Years)
 
Employer #1
Employer: Phone Number:
(ex. 419-332-5111)
Address: City:
State: Zip Code:
Position Held: Date: From
To
Rate of Pay: (per hour)   (ex. 01/2005)
Were you subject to the Federal Motor Carrier Safety Regulations? Yes No
Was the job designated as a "Safety Sensitive Function" in any DOT-Regulated mode subject to Drug and Alcohol testing requirements by 49 CFR Part 40? Yes No
Reason for Leaving:


 
Experience and Qualifications - Driver
 
Current Drivers License
State: License #:
Type: Expiration Date:
(ex. 01/01/2005)
 
Previous License Held (If any)
State: License #:
Type: Expiration Date:
(ex. 01/01/2005)
 
License Information
Have you ever been denied a license permit or privilege to operate a motor vehicle? Yes No
Have any of your license permits or privileges ever been suspended or revoked? Yes No
 
Driving Experience
Check all that apply Vans Flats Dumps Tanks
# of Years:

 

Accident Record (Past three years - All accidents)
 
Accident #1
(Date) (Nature of Accident) (# of Fatalities) (# of Injuries)
 
Accident #2
(Date) (Nature of Accident) (# of Fatalities) (# of Injuries)
 

Traffic Convictions and License Forfeitures (Past three years - Moving violations only)
 
Conviction / Forfeiture #1
(Date) (Location) (Charge) (Penalty)
 
Conviction / Forfeiture #2
(Date) (Location) (Charge) (Penalty)
 
Conviction / Forfeiture #3
(Date) (Location) (Charge) (Penalty)
 
Conviction / Forfeiture #4
(Date) (Location) (Charge) (Penalty)



 
Criminal Conviction
 
Have you ever been convicted of a felony? Yes No
Date:
(ex. 01/01/1970)
Have you ever been convicted for use of drugs? Yes No
Note: A criminal conviction is not necessarily an absolute bar to employment. You may explain the circumstances if you wish.
 

DAC Services Authorization - Total Application Screening to Release Information
 
In connection with my application for employment (including contract for services) with you: I, the undersigned, understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, worker's compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state, and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from which state agencies, and state provided driving records.
I authorize, without reservation, any party or agency contacted by DAC to furnish the above mentioned information. Further, I hereby authorize any and all previous employers to release Safety performance history information to Spader Freight Services, Inc. for the purpose of investigation as required by Sections 382.405, 391.23 and Part 40 of the Federal Motor Carrier Safety Regulations.
 
Date of Birth: (ex. 01/01/1970) Gender: Male Female
Full Name: Social Security Number:
(ex. 123-123-1234)
*Digital Signature: Date:
(ex. 01/01/1970)
* Please type your full name into the field marked "Digital Signature". This field serves as a digital (electronic) copy of your signature and confirms your acceptance of the terms listed below. This signature also serves as your endorsement stating that all information supplied by you is complete and accurate to your knowledge.
 
Section 40.25(j) Compliance
 
The prospective employee is required by Section 40.25(j) to respond to the following questions.
Have you tested positive, or refused to test, on any pre-employment drug and alcohol test administered by an employer to which you applied for, but did not obtain, Safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past three years? Yes No
If you answered yes, can you provide or obtain proof that you have successfully completed the DOT return-to-duty requirements? Yes No