Home Driver Application Use the form below to inquire about driver opportunities with our company. Step 1 of 4 - Application 25% The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company Named above. INSTRUCTIONS TO APPLICANT Please answer all questions. If the answer to any question is "NO" or "NONE", do not leave the item blank - write "NO" or "NONE". THIS IS IMPORTANT! *The Age Discrimination of Employment Act ofm1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age. Position You Are Applying For? Applying For..* Contractor Driver Choose All that you want to apply for What Kind of Position* Temporary Full Time Part Time How Did You Hear About Us?* Web Search Job Posting Someone Referred me Rate of Pay Expected Your Personal Information Full Name (First + Middle + Last)* Permanent Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Have you Been At this Address less than 3 years?* Yes No Home Phone Cell Phone* Email* Age* Date of Birth* MM DD YYYY Social Security #* Other name(s) under which you have been previously employed General Information Have you ever applied to this organization before?* Yes No Do you have any relatives that worked for this company?* Yes No Have you worked for this company before?* Yes No Have you ever been convicted of a felony?* Yes No Education/U.S. Military Service Where did you attend high school & college? (Click the + button to add a new row)* School Name & Address Major Years Completed GPA Degree/Diploma Are you taking any educational course(s) presently?* Yes No I will be soon Have you ever served in the U.S. Armed Services? Yes No Employment History Give a COMPLETE RECORD of all employment for the past three years, including any unemployment or self employment, and all commercial driving experience for the past ten years Are You Currently Employed?* Yes No Employment history the last 3 years -10 years for driving (Click the + button to add a new row)* Company Name & Address Supervisor Name Posisition Salary From/To (Mo&YR) Reason you left References List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row) Name Address Occupation Years Known Acknowledgement Resume Upload (optional) Accepted file types: doc, pdf. Would you like to add a cover letter? Yes No TO BE READ AND SIGNED BY APPLICANT It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty. I give the motor carrier and its agents or representatives the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability for damages the motor carrier and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. 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 motor carrier to employ me. It is agreed and understood that if qualified to operate motor carrier equipment, I may be on a probationary period, during which I 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. Your Signature* Use your mouse or finger to sign Today's Date* © 2015 J&L Transportation | All Rights Reserved