Home About Services Gallery Jobs Employee Area Contact & Map Driver Application Form Driver Application Form Applicant Name Last Name MI Phone Number Social Security E-mail Position(s) Applied for Date of Application Current Address Current Street City State ZIP Code Previous Addresses Street City State ZIP Code How long? Street City State ZIP Code How long? Street City State ZIP Code How long? In case of emergency notify Full Name Relationship Phone Number Do you have the legal right to work in the United States? Yes No Date of Birth Have you ever worked for this company before? Yes No Where? Dates: From to Rate Position Reason for leaving Are you now employed? Yes No If not, how long has it been since leaving last employment? Who referred you? Can you perform, with or without reasonable accommodation, the essential functions of the job (as described in the attached job description)? Yes No TO BE READ AND SIGNED BY APPLICANT I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to: Review information provided by previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. Date Pre-Employment Interview Form Name Are you over 21 years old? Yes No Years of tractor trailer experience *Tractor trailer school only Name & Location of TT school Have you ever been convicted of reckless, careless, or negligent driving? Have you ever been convicted of driving under the influence of alcohol? Have you ever been convicted of driving under the influence of drugs? Have you ever been convicted of using a vehicle to elude an officer? Have you ever been convicted of leaving the scene of an accident? Has your right to operate ever been suspended or revoked? Have you ever been convicted of excessive speeding (15 MPH or over)? Have you ever been convicted of improper or erratic lane changes? Have you ever been convicted of following a vehicle too closely? Have you ever been convicted of a felony? Have you, during the last three (3) years, tested positive or refused to test on any pre-employment drug and/or alcohol test administered by any employer for which you have applied? Have you lived in the U.S. for the past 5 years uninterrupted? (USPS Requirement) "If the applicant was convicted of any of the above violations during the past (3) years, the applicant must be approved by the company Safety/Compliance Manager before being offered employment." Is your license current? Expiration Date Are you licensed in the state of your residence? State Do you have more than one active license? If so, why? Are you aware that you must pass a pre-employment drug screen? Are you physically capable of performing the required duties of the job for which you are applying? Date EMPLOYMENT HISTORY All driver applicants to drive in interstate commerce must provide the following information on all employers 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. Add another sheet as necessary.) EMPLOYER Name Address City State ZIP Contact Person Phone Number Were you subject to the FMCSRs** while employed? Yes No 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 4D? Yes No DATE From To Position held Salary/Wage Reason for Leaving EMPLOYER Name Address City State ZIP Contact Person Phone Number Were you subject to the FMCSRs** while employed? Yes No 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 4D? Yes No DATE From To Position held Salary/Wage Reason for Leaving EMPLOYER Name Address City State ZIP Contact Person Phone Number Were you subject to the FMCSRs** while employed? Yes No 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 4D? Yes No DATE From To Position held Salary/Wage Reason for Leaving *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous in a quantity requiring placarding. **The Federal Motor Carrier Safety Regulations(FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weigh or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous in a quantity requiring placarding. Accident record for the past 3 years or more. If none, write none Date of Last Accident Nature Accident (head-on, rear-end, etc) Fatalities Injuries Hazardous Material Bills Date of Next Previous Accident Nature Accident (head-on, rear-end, etc) Fatalities Injuries Hazardous Material Bills Date of Next Previous Accident Nature Accident (head-on, rear-end, etc) Fatalities Injuries Hazardous Material Bills Traffic convictions and forfeitures for the past 3 years (other than parking violations). If none, write none Location Date Charge Penalty Location Date Charge Penalty Location Date Charge Penalty Experience and Qualifications - Driver Driver licenses or permits held in the past 3 years State License Number Class Endorsement(s) Expiration Date State License Number Class Endorsement(s) Expiration Date State License Number Class Endorsement(s) Expiration Date A. Have you ever been denied a license, permit or privilege to operate a motor vehicle Yes No B. Has any license, permit or privilege ever been suspended or revoked Yes No If the answer to either A or B is YES, give details Driving Experience Class of Equipment (Straight Truck) Yes No Circle Type of Equiment (Van, Tank, Flat, Dump, Refer) Date From Date To Approx. # of Miles (Total) Class of Equipment (Tractor and Semi-Tailer) Yes No Circle Type of Equiment (Van, Tank, Flat, Dump, Refer) Date From Date To Approx. # of Miles (Total) Class of Equipment (Tractor - Two Tailers) Yes No Circle Type of Equiment (Van, Tank, Flat, Dump, Refer) Date From Date To Approx. # of Miles (Total) Class of Equipment (Tractor - Three Tailers) Yes No Circle Type of Equiment (Van, Tank, Flat, Dump, Refer) Date From Date To Approx. # of Miles (Total) Class of Equipment (Motorcoach - School Bus - More than 8 passengers) Yes No Circle Type of Equiment Date From Date To Approx. # of Miles (Total) Class of Equipment (Motorcoach - School Bus - More than 15 passengers) Yes No Circle Type of Equiment Date From Date To Approx. # of Miles (Total) Other Circle Type of Equiment Date From Date To Approx. # of Miles (Total) List states operated in for the last five years 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 Education Highest grade completed 1 2 3 4 5 6 7 8 High School 1 2 3 4 College 1 2 3 4 Last School Attended Name City State TO BE READ AND SIGNED BY APPLICANT 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 Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records And Changes in Parts 390 and 391 of FMCSA Date Social Security Print Name (First, MI, Last I, the above-mentioned signe, hereby authorized To release and forward in accordance with the following regulation, all known information pertaining to my alcohol controlled substances testing/training records to R&F Transportation Co., Inc. DOT DRUG AND ALCOHOL RELEASE I authorize, per 49 CFR Part 40, the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed to Assurant or other designed provider for the sole purpose of transmitting such records to R&F Transportation Co., Inc. or directly to R&F Transportation Co., Inc. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol test 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 the previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of the completion of a return-to-duty process the following a rule of violation. SUBMIT FORM Contact Us 35 Dana Street Taunton, MA 02780 PHONE: (508) 824-4547 FREE: (800) 824-4439 FAX: (508) 824-0118 EMAIL: postoffice@rftrans.com About R&F Transportation Currently contracted with the United States Postal Service, we have a mixed fleet of straight trucks and tractor trailers. All website content R&F Transportation> © 2014, All Rights Reserved Website Developed by Highersite Translate »