auto-van-rv-delivery ~ employment opportunities




Pickup truck driver Drive a way driver Apply for Both
Type vehicle you want to lease on

First name Surname Middle Date of Birth (ie: June/01/1968) Phone Number		Street City State Zip Email Address
How long at your current address?

Street City State Zip How long at your previous address?		Street City State Zip How long at your previous address?

Do you have the legal right to work in the United States? Yes No Can you provide proof of age? Yes No		Have you worked for this company before? Yes No Where? From: To:

Rate of Pay Position Reason for leaving		Are you now employed? Yes No If not, how long since leaving last employment?

Who referred you		Rate of pay expected
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description? Yes No ( If yes, Please Explain in the area below. )

All driver applicants who 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 ADDRESS CONTACT PERSON DATE CITY PHONE NUMBER NAME STATE REASON FOR LEAVING FROM TO MO. YR MO. YR ZIP POSITION HELD SALARY/WAGE *Include vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding(Keep the Same Format and add additional information below.

Accident record for past 3 years or more (attach sheet if more space if needed). If none, write none. DATES NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.) FATALITIES INJURIES LAST ACCIDENT NEXT PREVIOUS

Traffic convictions and forfeitures for the past 3 years (other than parking violations). If none, write none. LOCATION DATE CHARGE PENALTY (ATTACH SHEET IF MORE SPACE IF NEEDED)

Checkmark highest Grade completed: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4		Name: City State


DRIVER STATE LICENSE NO.		TYPE EXPIRATION DATE DRIVER LICENSES

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 below.

If none, write none.
CLASS OF EQUIPMENT TYPE OF EQUIPMENT (Van, tank, flat, etc.) FROM / TO Approx. No. of Miles (TOTAL) Straight Truck Tractor		Semi-Trailer Tractor Two Trailers Motor Coach School Bus 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 List special equipment or technical materials you can work with (other than those already shown).
Email us any additional information that you would like to add sales@auto-van-rv-delivery.com

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. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
I Agree to the above terms and conditions
Date:		Signature: