Stepp's Towing & Transport Driver's Application For Employment

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, matital status, or non-job related disability.

Position(s) Appilied for:

First Name: Last Name:

Social Security No:

List Your Addresses of Residency for the past 3 years

Current Address:

Street: City:

State: Zip Code: Phone: How Long?

Previous Address:

Street: City: State: Zip Code: How Long?

Previous Address:

Street: City: State: Zip Code: How Long?

Previous Address:

Street: City: State: Zip Code: How Long?

Do you have the legal right to work in the United States?

Date Of Birth: Can You Provide Proof of Age?

Have you worked for this company before?
Where?

Dates: From To? Rate of Pay: Position:

Reason for Leaving:

Are you now employed?
If not, how long since leaving last employment?

Who referred you?
Rate of pay expected:

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job desctipon)?

If yes, explain if you wish:

ACCIDENT RECORD FOR PAST 3 YEARS

Dates	Nature of Accident	Fatalities	Injuries
Last Accident:
Next Previous:
Next Previous:

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

Location	Date	Charge	Penalty

EDUCATION

Highest Grade Completed?

Highest Grade For High School?

Highest Grade For College?

Last School Attended, Name:
City:

EXPERIENCE AND QUALIFICATIONS - DRIVER

	State	License No	Type	Expiration Date
Driver Licenses

A. Have you ever been denied a license or
privilege to operate a motor vehicle?

B. Has any license, permit or privilege ever been suspended or revoked?

IF THE ANSWER TO EITHER
A OR B IS YES, PLEASE GIVE DETAILS

DRIVING EXPERIENCE

Class of Equipment	Type of Equipment	From Date	To Date	Approx. No. Of Miles
Straight Truck
Tractor/Semi Trailer
Tractor/Two Trailer
Motorcoach/School Bus
Other

List States Operated in For Last Five Years:

Show Special Courses Or Training That Will Help You as a Driver:

Which Safe Driving Awards Do You Hold and From Whom?

Experience And Qualifications - Other

Show Any Trucking, Transportation or Other Experience That May Help In Your Work For This Company:

List Courses And Training Other Than Shown Elsewhere In This Application:

List Special Equipment Or Technical Materials You Can Work With (Other than already shown):

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employees during the preceding 3 years. List complete mailing address, street number, city, state, and zip code.
Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with the most recent.)

Name:	From: To:
Address:	Position Held:
City: State: ZipCode:	Salary / Wage:
Contact: Phone:	Reason For Leaving:

Name:	From: To:
Address:	Position Held:
City: State: ZipCode:	Salary / Wage:
Contact: Phone:	Reason For Leaving:

Name:	From: To:
Address:	Position Held:
City: State: ZipCode:	Salary / Wage:
Contact: Phone:	Reason For Leaving:

Name:	From: To:
Address:	Position Held:
City: State: ZipCode:	Salary / Wage:
Contact: Phone:	Reason For Leaving:

Name:	From: To:
Address:	Position Held:
City: State: ZipCode:	Salary / Wage:
Contact: Phone:	Reason For Leaving: