Drivers Application For Employment - Mcclays Transportation USA

DATE OF APPLICATION:*

POSITION:*

Name*

First Last

SOCIAL SECURITY #*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

PHONE NUMBER:*

DATE OF BIRTH:*

DRIVERS LICENSE #:*

CLASS:*

EXP DATE:*

E-MAIL ADDRESS:*

Can you legally cross the U.S. Border:*

Yes
No

Are you presently employed?*

Yes
No

If no, how long since leaving last appointment:

Date you would be available for employment:*

PHYSICAL HISTORY

Would you be willing to submit to a pre-employment medical examination?*

Yes
No

Would you be willing to submit to a pre-employment urinalysis (substance abuse) test?*

Yes
No

Do you have physical limitations, which may limit your ability to perform the job applied for?*

Are you physically capable of performing heavy manual labor?*

Yes
No

How much lost time due to injury have you suffered in the past 3 years?*

EMPLOYMENT HISTORY - Employer 1

Employer Name:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Contact Person:

First Last

Employer Phone Number:

Position Held

Date From and To Employment Term:

Salary Wage:

Reason For Leaving:

EMPLOYMENT HISTORY - Employer 2

Employer Name:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Contact Person:

First Last

Employer Phone Number:

Position Held

Date From and To Employment Term:

Salary Wage:

Reason For Leaving:

EMPLOYMENT HISTORY - Employer 3

Employer Name:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Contact Person:

First Last

Employer Phone Number:

Position Held

Date From and To Employment Term:

Salary Wage:

Reason For Leaving:

EXPERIENCE, EDUCATION AND QUALIFICATIONS

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

Yes
No

Has any license, permit or privilege to drive ever been suspended or revoked?*

Yes
No

What safe driving awards do you hold?

How man accident-free driving years do you currently have?*

List any motor vehicle accidents have you been involved in during the past 5 years

PLEASE INCLUDE: DATE, NATURE OF ACCIDENT, FATALITIES & INJURIES FOR EACH ACCIDENT.

List any special courses, training or background you might possess?

List your Educational Background beginning with the school most recently attended*

PLEASE INCLUDE: DATES, SCHOOLS AND COURSES TAKEN.

List the States you have operated a commercial vehicle in during the past 5 years:*

Are there any states that you will not or cannot operate in? List:

Are you able to complete a log book properly?*

Yes
No

If no explain:

Have you ever been trained to transport Dangerous Goods?*

Yes
No

If Yes where:

Which classes of Dangerous Goods have you transported?

For each employer listed on page 2, please list the type of equipment operated. Exp: flatbed, van, tanker, etc.

PLEASE INCLUDE: EMPLOYERS, TYPE OF EQUIPMENT & LENGTH OF TIME.

In order to properly evaluate your application we ask you to list in the space provided below the special skills or reasons that you believe would help to make you an integral part of our team.*

MCCLAY TRANSPORTATION USA LLC TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by myself, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize (McClay’s Transportation USA LLC) 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. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.

In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in my being discharged. I understand, also, that I am required to abide by all rules and regulations (McClay’s Transportation USA LLC) as permitted by law.

Date*

Name*

First Last

THIS FIELD ACTS AS YOUR DIGITAL SIGNATURE.

EMERGENCY RESPONSE

Name*

First Last

Date*

Whom should we contact in case of an emergency?*

Telephone Number:*

Relationship:*

Do you have any medical conditions we should be aware of?*

If unable to contact the above person, may we contact your personal doctor?*

Yes
No

Dr. Name

Dr. Telephone Number

Phone

This field is for validation purposes and should be left unchanged.