HOME ABOUT US SERVICES OUR TEAM CAREERS CONTACT US Driver Application Fill out the online application or download a version to submit. DOWNLOAD OUR APPLICATION The purpose of this application is to determine whether or not the applicant is qualified to operate Motor Carrier equipment according to the Federal Motor Carrier Safety Regulations and to operate for Utley, Inc. Driver Application First Name(*) Middle Name(*) Last Name(*) Applying For(*) Select One Contractor Driver Age(*) Date of Birth(*) Phone Number(*) Current & Previous Addresses (Last 3 Years) Please answer all questions. If the answer to any question is “No” or “None,” do not leave the item blank, but write “No” or “None.” This is important! Current Address(*) City(*) State(*) Zipcode(*) From(*) Previous Address 1 City State Zipcode From To Previous Address 2 City State Zipcode From To Previous Address 3 City State Zipcode From To Employment Give a COMPLETE RECORD of all employment for the past 10 years, including any unemployment or self-employment. DO NOT leave gaps in employment dates. DO NOT use N/A, you must list or say NONE. Previous Employer 1(*) Address(*) City(*) State(*) Zipcode(*) From(*) To(*) Position Held(*) Salary(*) Safety Sensitve?(*) Select One Yes No Reasons for Leaving(*) FB VAN Reef Tank Previous Employer 2 Address City State Zipcode From To Position Held Salary Safety Sensitve? Select One Yes No Reasons for Leaving FB VAN Reef Tank Previous Employer 3 Address City State Zipcode From To Position Held Salary Safety Sensitve? Select One Yes No Reasons for Leaving FB VAN Reef Tank Previous Employer 4 Address City State Zipcode From To Position Held Salary Safety Sensitve? Select One Yes No Reasons for Leaving FB VAN Reef Tank Previous Employer 5 Address City State Zipcode From To Position Held Salary Safety Sensitve? Select One Yes No Reasons for Leaving FB VAN Reef Tank Previous Employer 6 Address City State Zipcode From To Position Held Salary Safety Sensitve? Select One Yes No Reasons for Leaving FB VAN Reef Tank Driving Experience Straight Truck From To Approximate # of Miles Tractor and Semi Trailer From To Approximate # of Miles Tractor-Two Trailers From To Approximate # of Miles Other From To Approximate # of Miles List Special Courses or training that will help you as a driver What Safe Driving Awards do you hold and from whom? Accident Record for Past 3 Years Accident Date Nature of Accident (Head-on, Rear-end, Roll-over, etc.) # of Fatalities # of People Injured Accident Date Nature of Accident (Head-on, Rear-end, Roll-over, etc.) # of Fatalities # of People Injured Accident Date Nature of Accident (Head-on, Rear-end, Roll-over, etc.) # of Fatalities # of People Injured Accident Date Nature of Accident (Head-on, Rear-end, Roll-over, etc.) # of Fatalities # of People Injured List any other accident information here Traffic Convictions And Forfeitures For The Past 3 Years Location Date Charge Penalty Location Date Charge Penalty Location Date Charge Penalty Location Date Charge Penalty Drivers License (List each driver's license held in the past 7 years) State License Number Type Endorsements Expiration Date State License Number Type Endorsements Expiration Date State License Number Type Endorsements Expiration Date State License Number Type Endorsements Expiration Date Have you ever been denied a license, permit or privilege to operate a motor vehicle? Select One Yes No Has any license, permit, or privilege ever been suspended or revoked? Select One Yes No If you answered yes to either question above, please explain. Personal References List three persons for reference, other than relatives, who have knowledge of your safety habits. Name Phone Number Address Name Phone Number Address Name Phone Number Address To Be Read And Signed By Applicant It is agreed and understood that any misrepresentation given above 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 ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability or any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Report Act, Public Law 91-508, I have been told this investigation may include an Investigation Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. It is agreed and understood that this application for qualification in no way obligates the company to employ the applicant. It is agreed and understood that if qualified, the driver may be on a probationary period during which time he/she 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. Date Applicant's Signature (*) SUBMIT APPLICATION ABOUT US Utley Inc. is a third generation, family owned premium flatbed carrier emphasizing quality and safe service. QUICK LINKS About Us Services Our Team Careers CONTACT US P.O. Box 207 Steele, Missouri 63877 info@utleyinc.com © Copyright 2021. Utley Inc. | Privacy Policy