Myers Trucking Inc. - Driver's Application for Employment

Position Applied For *

Date * +

Last Name *

First Name *

Middle Name *

Date of Birth * +

Street Address *

City *

State *

Zip Code *

Years at this address? *

Other Address?

Expected Rate of Pay *

Phone Number *

Are you now employed? *

If not, how long since last employment?

Who Referred You?

Employment History 1

All Driver applicants to drive in interstate commerce must provide the following information on all employers during the preceeding 3 years. List complete mailing addresses, 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 first.

Company Name *

Contact Person *

Phone Number *

Street Address *

City *

State *

Zip Code *

From * +

To * +

Position Held *

Salary / Wage *

Reason for Leaving *

Were you subject to the FMCSRs while employed? *

Was your job designated as a safety-sensitive function in any Dot-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40$ *

Employment History 2

NOTE: List employers in reverse order, starting with the most recent first.

Company Name

Contact Person

Phone Number

Street Address

City

State

Zip Code

From +

To +

Position Held

Salary / Wage

Reason for Leaving

Were you subject to the FMCSRs while employed?

Was your job designated as a safety-sensitive function in any Dot-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40$

Any other employment?

If more than two employers, enter the same information here for any additional

Experience and Qualifications - Driver

Driver Licenses or permits held in the past three years

State *

License Number *

Class *

Endorsements *

Expiration Date * +

State

License Number

Class

Endorsements

Expiration Date +

State

License Number

Class

Endorsements

Expiration Date +

State

License Number

Class

Endorsements

Expiration Date +

A: Have you ever been denied a license, permit 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 above is yes, give details

Driving Experience

Straight Truck *

From +

To +

Approximate number of miles

Tractor & Semi Trailer *

From +

To +

Approximate number of miles

Tractor - Two Trailers *

From +

To +

Approximate number of miles

Tractor Three Trailers *

From +

To +

Approximate number of miles

Other

Benefits

Company Driver Benefits:

Paid vacation
Paid Holidays
401K
Health, Dental and Vision Benefits

Owner/Operators Benefits:

ELD services offered through Keep Truckin’ with an Apple Ipad tablet provided
Road taxes paid by MTI
Partnership with Davevic Benefits Consultants Inc. with access to Independent Contractor benefits for health insurance www.davevic.com