Application for Qualification
Company Driver
In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status, or non-job related disability.
* Indicates required field. Date of Application:  09/08/2010
Personal Information
* First Name: * Middle Name: * Last Name:
* Primary Phone: (XXX-XXX-XXXX) Alternate Phone: (XXX-XXX-XXXX)
Email Address: * Date of Birth: (MM/DD/YYYY)
List addresses of residency for the past three (3) years.
Current Residence
* Address: * City:
County: * State: * Zip Code:
 Check here if no further Residence information can be supplied.
Previous Residence 1
* Address: * City:
County: * State: * Zip Code:
 Check here if no further Residence information can be supplied.
Previous Residence 2
* Address: * City:
County: * State: * Zip Code:
 Check here if no further Residence information can be supplied.
CDL & Endorsements
* Class: * State: * Expiration Date: (MM/DD/YYYY)
Check all the endorsements that apply
 (T) Double/Triple  (P) Passenger  (N) Tank  (H) HAZMAT  (X) Tank/HAZMAT
Education & Training
* Choose the highest educational grade you have completed.
Please list any special courses or training which has helped you prepare for commercial driving.
General Information
* Do you have a legal right to work in the United States? Yes No
* Have you worked for this company before? Yes No   When? (MM/YYYY)
What type of work do you prefer?  Check all that apply. Local Regional OTR Dedicated
* Have you been denied a license, permit or privilege to operate a motor vehicle? Yes No
Supply date and circumstances.
* Has any license, permit or priviledge ever been suspended or revoked? Yes No
Supply date and circumstances.
* Have you been convicted or plead no contest to any drug or alcohol related offense? Yes No
Supply date and circumstances.
* Have you ever tested positive, or refused to test, in an employment-related drug or alcohol test? Yes No
Supply date and circumstances.
* Have you been convicted of a criminal offense, including felony? Yes No
Criminal Offense 1
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 2
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 3
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 4
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 5
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
* Is there any reason you would be unable to transport into Canada? Yes No
Why?
Is there any reason you might be unable to perform the functions of the job applying for? Yes No
Explain if you wish.
Select states operated in the last 5 years.
(Hold the ctrl key down to make multiple selections)
Driving Experience
Which safe driving awards do you hold and from who?
Class of Equipment Date From (MM/YYYY) Date To (MM/YYYY) Total Miles (approx.)
Tanker
Tractor and Semi-Trailer
Accident Record
* Have you had an accident involving a commercial motor vehicle in the past 3 YEARS.? Yes No
Accident 1
* Date: (MM/YYYY) * Nature of Accident:
* Preventable? * Number of Fatalities: * Number of People Injured:
 Check here if no further Accident information can be supplied.
Accident 2
* Date: (MM/YYYY) * Nature of Accident:
* Preventable? * Number of Fatalities: * Number of People Injured:
 Check here if no further Accident information can be supplied.
Accident 3
* Date: (MM/YYYY) * Nature of Accident:
* Preventable? * Number of Fatalities: * Number of People Injured:
 Check here if no further Accident information can be supplied.
Accident 4
* Date: (MM/YYYY) * Nature of Accident:
* Preventable? * Number of Fatalities: * Number of People Injured:
 Check here if no further Accident information can be supplied.
Accident 5
* Date: (MM/YYYY) * Nature of Accident:
* Preventable? * Number of Fatalities: * Number of People Injured:
 Check here if no further Accident information can be supplied.
Traffic Violations
* Have you had any traffic convictions in the past 3 YEARS(other that parking violations).? Yes No
Traffic Violation 1
* Date: (MM/YYYY) * Location: * Charge: * Penalty:
 Check here if no further Traffic Violation information can be supplied.
Traffic Violation 2
* Date: (MM/YYYY) * Location: * Charge: * Penalty:
 Check here if no further Traffic Violation information can be supplied.
Traffic Violation 3
* Date: (MM/YYYY) * Location: * Charge: * Penalty:
 Check here if no further Traffic Violation information can be supplied.
Traffic Violation 4
* Date: (MM/YYYY) * Location: * Charge: * Penalty:
 Check here if no further Traffic Violation information can be supplied.
Traffic Violation 5
* Date: (MM/YYYY) * Location: * Charge: * Penalty:
 Check here if no further Traffic Violation information can be supplied.
Employment History
All driver applicants, to drive in interstate commerce, must provide the following information on all employers during the 3 years preceeding the date of this application, and an additional 7 years on those employers for whom you have operated a commercial motor vehicle in intrastate or interstate commerce.
Begin with your present or most recent job and work back in order, including full and part-time employment.   Click "Add Another Employer" to add additional employer records.
 Check here if you have no employment history.
Employer 1
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 2
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 3
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 4
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 5
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
How/who referred you to Fort Transfer?
Terms & Conditions

The facts set forth in my application are true and correct.  I understand that, if employed, false statements on this application will be considered sufficient cause for dismissal.  I hereby authorize Fort Transfer Company or its agents to make an investigation of my employment and personal history through any investigative or credit agencies of its choice.  I understand, also, that I am required to abide by all rules and regulations of Fort Transfer Company.

I also understand that neither this application nor a commitment of employment by Fort Transfer Company constitutes a contract of employment.  If a contract is to exist, that document will be executed in writing by Fort Transfer Company.  I understand that this application for employment is valid for no more than 30 days.   After that, I must resubmit an application in order to be considered for positions at Fort Transfer Company.   I agree, if hired, to furnish such additional information and complete such examinations as may be required to complete my employment file.

By submitting this application, I signify that I have read and agree to the terms set forth in the disclaimer.