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Driver's Application for Employment

Complete all fields and hit the 'complete application and submit for review' button at the end of this form. You will receive a confirmation number to indicate your application was received.

Location: 

In compliance with Federal and State Equal Employment Opportunity Commission (EEOC) laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or disability.
All questions on this form must be completed.

Name [first | middle | last]
Social Security #
Birthdate *(mm/dd/yyyy)
Position Applying For Home Phone
License Type/Class Secondary Phone
Type of Truck County
Email
Addresses For Past Three Years 
Street City State Zip How Long
 

Have you applied or worked for TLC before?
Who referred you to TLC?
Do you have the legal right to work in the US?
List any local, city or county taxes you are subject to:
Are you employed now?
If NO, how long since leaving your last employment?
What school district do you live in?
Is there any reason you might be unable to perform
the functions of the job for which you have applied,
with or without reasonable accommodation?
If YES, please explain:

Emergency Information
In case of emergency contact:
Name
Relationship
Phone
City, State



All drivers must provide the following information on all employers during the preceding three years. List complete address and phone number for each employer. If applying for a position driving a commercial motor vehicle*, you must also provide an additional seven years of employment information for those employers for whom the applicant operated such vehicle (a total of 10 years). Your present and previous employers will be contacted for the purpose of investigating your safety performance history as required by 391.23 of the FMCSRs.

Employment History 
Employer Name
Address
City
State
Zip
Dates [from: mo/yr]
Dates [to: mo/yr]
Position
Salary/Wage
Contact
Phone
Reason for Leaving
Were you subject to the FMCSRs? 
Were you subject to DOT Drug/Alcohol Testing? 

* Includes vehicles having a GVWR of 26,001 lbs or more, vehicles designed to transport 16 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.


Experience and Qualifications - Driver

Driver License Information 

State License No. Type Expiration Date
 


Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Has any license, permit or privilege ever been suspended or revoked?
Have you ever been convicted of a felony?
(If you are a Massachusetts resident or are applying for work in Hawaii,
Minnesota, Rhode Island, Buffalo NY, Philadelphia PA, or Newark NJ you may
disregard the felony question. Answering Yes to this question will not
automatically disqualify you from being hired.)
Have you ever tested positive for, or refused to take, a pre-employment or
random Drug and/or Alcohol test in the past Three (3) years?

For any YES answers to the above questions, please provide details:

Driving Experience 
Class of Equipment Type of Equipment
(van,tank,flat,etc.)
Dates
From:
To: Approx.No.Miles
(total)
 
States Operated In 

To select multiple states, hold down the Ctrl key and select states individually or hold down the Shift key and select a range.

Driving Record
Accident Record For Past Five Years Or More 
Date Nature of Accident
(Head-on, Rear-End, Upset, Etc.)
Fatalities Injuries
 


Hours of Service Violations, Traffic Convictions and Forfeitures for the Past Five Years (Other than Parking Violations) 
Location Date Charge Penalty
 


Education
Highest Grade Completed 
Last School Attended
Date




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 those shown elsewhere in this application:
List special equipment or technical materials you can work with(other than those already shown):


To be read and signed by applicant

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

I authorize you to make such investigations and inquiries of my personal, employment, financial and other related matters as may be necessary in arriving at an employment decision. I understand that consumer reports may be requested from HireRight. These reports may include: previous employer verifications, reason for termination, accidents, driving records, workers compensation claims, etc. I further understand that such reports may contain information from federal, state or other agencies. I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I further authorize The TLC Companies to release any and all information regarding myself to any of its lessees that TLC may consider assigning me to. You have the right to review information provided to us by your previous employers and have any errors in such information corrected by your previous employer as stated in section 391.23 (i) of the FMCSRs. Should you wish to review this information you must submit a written request to us, your prospective employer, as stated in section 391.23 (i) of the FMCSRs.

I authorize, per 49 CFR Part 40 of FMCSRs, the release of information from my DOT regulated drug and alcohol testing records by my previous employers to HireRight for the sole purpose of transmitting such records to The TLC Companies and its representatives/agents/clients. I authorize the release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of drug and alcohol rule violation(s); and (vi) documents, if any, of completion of return-to-duty process following a rule violation. I hereby authorize my worksite employer to submit copies of my current and future drug test results to the TLC Companies. This authorization shall expire if and when my worksite employer is no longer a client of the TLC Companies. The information I have authorized HireRight to review involves tests required by the DOT. If any carrier/company/school for whom I was previously employed furnishes HireRight with information concerning items (i) through (vi) above, I also authorize that carrier/company/school to release and furnish the dates of my negative drug and/or alcohol tests with results below 0.04 during the three year period and the name and phone number of any substance abuse professionals who evaluated me during the past three years.

The TLC Companies participates in E-Verify, which means if you are hired information from your I-9 form will be provided to the Social Security Administration, and if necessary, the Department of Homeland Security, to confirm work authorization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

 By checking this box, I consent to my physical signature and certify that the information is true and correct.


Disclosure and Authorization - Consumer Reports

Disclosure:

As part of your application for employment or your interest in being qualified as a contractor with The TLC Companies (the "Company"), the Company intends to obtain a consumer report and criminal background screen from consumer reporting agencies such as HireRight and/or US Information Search. These consumer reports will be used for employment purposes within the meaning of the Fair Credit Reporting Act (the "FCRA"). To the extent you enter into an employment or contractual relationship with the Company, the Company may periodically obtain updated consumer reports and criminal background screens. Among the reports that may be procured by the Company are reports from the Pre-Employment Screening Program (PSP) conducted by the Federal Motor Carrier Safety Administration (the information obtained from this program is hereinafter referred to as a "PSP Report").

As required by the FCRA, this disclosure is to inform you that a consumer report, including information as to character, general reputation, personal characteristics, and mode of living, whichever are applicable, may be procured from time to time. Such reports may contain public information concerning your driving record, safety record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies, which maintain such records. Consumer reports and background checks are conducted only in accordance with state and local laws.

Should the information received in the consumer report be the reason in whole or in part for any adverse action taken against you by the Company, you may obtain a free copy of the consumer report from the consumer reporting agency so long as the report is requested within 60 days of notification of the adverse action. You have the right to dispute the accuracy or completeness of any information contained in the consumer report furnished by the consumer reporting agency.

Authorization:

This signed Authorization is my authorization and consent for the Company to procure consumer reports and criminal background reports from a consumer reporting agency, including a PSP Report, from time to time as required by the Company for employment or contract purposes.

This authorization shall remain on file and shall serve as on-going authorization for the Company to procure consumer and criminal background reports, including PSP Reports, at any time during my employment or contractual relationship and the qualification process with respect thereto. I understand that, upon termination of my employment or contract for any reason, this authorization shall be destroyed and of no further effect.

I hereby certify that I have read the foregoing and understand the contents of this Disclosure and Authorization. I also understand the remedies available to me should I disagree with the Consumer Reporting Agency with respect to the consumer report.

 By checking this box, I consent to my physical signature and certify that the information is true and correct.


Essential Job Functions - Commercial Truck Driver (Class A & B)

The following are physical requirements pertaining to the job(s) for which you are applying. These bona fide physical requirements are essential functions of the job and are in addition to the skill, certification, years of experience and other qualifications required to perform the job(s) for which you have applied.

Please be aware that all persons may be required to furnish health condition information and if necessary, submit to an examination by a company-designated physician. This information will be used to determine appropriate job placement. It shall not be used to disqualify an otherwise qualified person who may have a mental or physical disability who can perform these essential functions with or without reasonable accommodations.

These statements/questions pertain only to the essential functions of the job for which you are applying.

  1. Can you sit and drive as is required for an 11-hour shift?

  2. Can you perform repetitive motion tasks with your hands and wrists?

  3. Can you push and pull levers or objects that require 100 lbs. of force or more?

  4. Do you have free and continual movement of your legs and feet as required to safely operate a clutch, brake and gas pedal or foot controls of a truck?

  5. If required, are you able to you reach and lift 60 lbs. above your head?

  6. Can you climb stairs to safely get in an out of a truck or with a load regularly?

  7. Can you grip, grasp and twist using your hands and wrists constantly as is required to safely operate the steering, shifting or other mechanical or hydraulic controls of a truck?

  8. If required, are you able to lift and move 100 lbs. or more?

  9. Is there any reason you may not be considered physically qualified to operate a commercial motor vehicle per the qualifications set forth in part 391.41 of the Federal Motor Carrier Safety Regulations?

     If Yes, please explain:

For any No answers to questios 1-8 above, please explain:

Prompt and reliable attendance is a job requirement.
I understand that any misstatement, omission, falsification, or misrepresentation of fact on this form is grounds for withdrawal of the conditional job offer or termination of employment if already employed.

 By checking this box, I consent to my physical signature and certify that the information is true and correct.

Complete application and review for accuracy before clicking submit. Once the application has been submitted it cannot be edited but may be printed for review.

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