Guy Shavender Trucking Inc.

Online Application Form

Driver Information

First Name:  MI:  Last Name:

Social Security Number:

Address:
City:                       E-Mail Address:
State:
Zip:
Phone:                    Date Of Birth: MM/DD/CCYY

Miscellaneous Information

CDL Driver's Liscense #: Expiration Date:MM/DD/CCYY

State:

Years Of Experience:

Hazardous Materials Endorsement:     Yes    No

Have you ever been convicted of a felony?     Yes    No

If yes, explain:

Has your license ever been suspended/revoked?             Yes    No
When? MM/DD/CCYY             Where?

Have you ever been convicted of a DUI/DWI?       Yes    No
When? MM/DD/CCYY

Number of moving violations in the last 3 years?    

Any accidents in the last 3 years?    Yes     No
How Many?      When? MM/DD/CCYY
Who was at fault?     Damage Amount:

Type of equipment operated and number of years each:

Van No. of years  Tanker No. of years Flatbed No. of years 
Other: No. of years

Current Employer Information

Current Employer:       Position:

Dates of Employment...     From:MM/DD/CCYY   To:MM/DD/CCYY

Pay:

City:          State:

Phone:      Contact:

Why did you leave?

Past Employer (1) Information

Past Employer:         Position:

Dates of Employment...          From:MM/DD/CCYY   To:MM/DD/CCYY

Pay:

City:         State:

Phone:     Contact:

Past Employer (2) Information

Past Employer:         Position:

Dates of Employment...         From:MM/DD/CCYY    To:MM/DD/CCYY

Pay:

City:         State:

Phone:      Contact:

Why did you leave?

I certify that I personally completed this application and that all of the information is true and correct. I authorize Guy Shavender Trucking, Inc. to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Guy Shavender Trucking, Inc. and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alchohol test taken by me pursuant to the provisions of 49 CFR while in their employment to Guy Shavender Trucking, Inc. by whatever means is most expedient.

This form created by Jim Helms
Copyright © 1999 Guy Shavender Trucking Inc. All rights reserved.
Revised: August 12, 2008.