Driver Application Personal Information Date of application Drivers License Expiration Date Present Address* Previous Address(es) during last 3 years (FMCSR 391.21 (3))* Date of Birth (required by FMCSR 391.21 (2) to verify motor vehicle report)* In case of emergency notify Phone Emergency 1 Phone Emergency 2 Aternate Emergency Phone # Have you applied for work and / or worked for this company before? Yes No When? If hired, can you present evidence of your U.S. Citizenship or proof of your legal right to live and work in this country? Yes No Position which applying for: Are you able to perform the essential functions and duties of the job as contained in the job description with reasonable accommodation? Yes No How did you find out about Gamer Logistics? Employee Referral Other Who? Please read carefully A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Any license, permit or privilege been suspended or revoked? Yes No C. Have you ever been stopped while intoxicated? Yes No D. During the past two (2) years have you tested positive on a Pre-employment alcohol or drug test administired by Employer to which you applied for but did not obtain a Driver position regulated bye the DOT drug and alcohol testing rules? Yes No E. During the past two (2) Years have you refused to test on a Pre-employment alcohol or drug test administered by an Employer to which you applied for but did not obtain a Driver position regulated by the DOT drug and alcohol testing rules? Yes No F. Have you ever been convicted for possession of, sale, or use of a narcotic drug, amphetamine, or a derivative thereof? Yes No G. Have you ever been convicted of a criminal offense? (A conviction will not necessarily disqualify you from employment.) Yes No H. Do you currently have any criminal actions pending in which you are a defendant? (A "yes" answer will not necessarily disqualify you from employment.) Yes No I. Are you currently on probation or parole status? (A "yes" answer will not necessarily disqualify you from employment.) Yes No If yes to any of the above questions, state circumstances and dates: Education Highest grade completed arrow&amp;v List other specialty training or schools Military Status Have you served in the U.S. Armed Forces? Yes No Branch From To Duties Employment record for past 10 years DOT Regulations require: START YOUR MOST RECENT JOB. If your driving experience is less than 3 years, than write down all your work experience for the past 3 years. If your driving experience is more than 3 years but less than 10 years, then write all of your driving experience. No need to write down any driving experience that is over 10 years. Reglamento del DOT: INICIE CON SU TRABAJO MÁS RECIENTE Y ANOTE PROGRESIVAMENTE Si su experiencia de manejo es más de 3 años pero menos de 10 años, enliste toda su experiencia de manejo. No necesita anotar experiencia de trabajo mayor a 10 años. IF YOU HAVE BEEN UNEMPLOYED FOR SOME TIME, PLEASE INDICATE DATES AND REASON BELOW Gap in employment Explain the reason for gap in employment Unemployed Vacation Illness In jail Other (1) Current or most recent employer May we call? arrow&amp;v Type of Truck Driven Tractor Box-Truck Bus Other Type of Trailer Pulled Dry Van Flatbed Low-Boy Other Job Position Held OTR Driver Local Driver Other Accidents Accidents arrow&amp;v Explain the reason for leaving Looking for better job Fired Company closed Other Gap in employment between job (1) and (2) Explain the reason for gap in employment Unemployed Vacation Illness In jail Other Second most recent employer May we call? arrow&amp;v Type of Truck Driven Tractor Box-Truck Bus Other Type of Trailer Pulled Dry Van Flatbed Low-Boy Other Job Position Held OTR Driver Local Driver Other Accidents Accidents arrow&amp;v Explain the reason for leaving Looking for better job Fired Company closed Other Gap in employment between job (2) and (3) Explain the reason for gap in employment Unemployed Vacation Illness In jail Other Third most recent employer May we call? arrow&amp;v Type of Truck Driven Tractor Box-Truck Bus Other Type of Trailer Pulled Dry Van Flatbed Low-Boy Other Job Position Held OTR Driver Local Driver Other Accidents Accidents arrow&amp;v Explain the reason for leaving Looking for better job Fired Company closed Other Gap in employment between job (3) and (4)* Explain the reason for gap in employment Unemployed Vacation Illness In jail Other Driver Experience Date from Straight Truck Tractor & trailer Tractor & reefer Other Date to Aproximate number of miles Traveled (Total) License Please upload a picture or copy of your driver license Load file Max. 15 Mb Moving traffic convictions list for past five (5) years. If none write none. States in which you hace operated a class-A motor vehicle in the past five years: References Please list 2 people able to verify your employment and personal history. Such as co worker, neighbor, customer or an upstanding citizen of your community. **DO NOT LIST RELATIVES** Reference 1 Reference 2 Send Terminal (915) 590-9700 Headquarters (915) 533-5700 Indianapolis Office (317) 279-6902 Ciudad Juárez Office +52 (656) 611-0745