Commercial DriverApplication
APPLICANT INFORMATION
Name: ______
First Initial Last Name
Address: ______
______
City Prov. Postal Code
______
Phone Email Address
Have you worked for G&B Fuels Inc. before? ______Yes ______No
If yes, give dates: From ______To ______
Reason for leaving? ______
EDUCATIONAL HISTORY
Highest Level of Grade School Completed ______
Highest Level of Post Secondary Completed ______
Other Courses / Certificates ______
______
______
______
______
EMPLOYMENT HISTORY
Give a Complete Record of all employment for the past 3 years, including any unemployment or self-employment periods and all commercial driving experience for the past 10 years
From ______To ______Employer ______
Position Held ______Address ______
Supervisor Name ______Phone ______
Reason for leaving ______
Currently work here ______Yes ______No
From ______To ______Employer ______
Position Held ______Address ______
Supervisor Name ______Phone ______
Reason for leaving ______
Currently work here ______Yes ______No
From ______To ______Employer ______
Position Held ______Address ______
Supervisor Name ______Phone ______
Reason for leaving ______
Currently work here ______Yes ______No
From ______To ______Employer ______
Position Held ______Address ______
Supervisor Name ______Phone ______
Reason for leaving ______
Currently work here ______Yes ______No
From ______To ______Employer ______
Position Held ______Address ______
Supervisor Name ______Phone ______
Reason for leaving ______
Currently work here ______Yes ______No
(Attach additional sheets for 10-year history, if needed)
DRIVING EXPERIENCE
Class of Equipment (Truck, Trailer, Super B, etc.)
______
______
______
Nature of work (Long haul, mountains, city, etc.)
______
______
______
ACCIDENT RECORD / TRAFFIC CONVICTIONS
List all accidents and traffic violations for the last 3 years (attach sheet if more space needed)
Date ______Type of Infraction ______
Equipment ______Location ______
Injury / Penalty ______
Date ______Type of Infraction ______
Equipment ______Location ______
Injury / Penalty ______
Date ______Type of Infraction ______
Equipment ______Location ______
Injury / Penalty ______
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes _____ No _____
If Yes, why? ______
______
Has any license, permit or privilege ever been suspended or revoked?
Yes _____ No _____
If Yes, why? ______
______
Is there any reason you might be unable to perform the functions of the job for which you are applying ?
Yes _____ No _____
If Yes, why? ______
______
JOB REFERENCES
List 3 persons for references who have knowledge of your safe driving habits (Employers/Supervisors)
Name ______Company ______
Address ______
Title ______Phone ______
Name ______Company ______
Address ______
Title ______Phone ______
Name ______Company ______
Address ______
Title ______Phone ______
To Be Read and Signed by Applicant:
It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.
It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of their furnishing such information.
I agree to furnish such additional information and complete such examinations as may be required to complete such examinations as may be required to complete my application file.
It is agreed and understood that this Application in no way obligates G&B Fuels Inc. to employ or hire the applicant.
I hereby agree to abide by G&B Fuels Inc. “Alcohol and Drug Policy” and agree to submit to periodic substance abuse testing as stated in the aforementioned policy.
It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.
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.
Applicant Signature______Date______
mailto:
1 | Page