TM - APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

5771 S Padre Island Hwy, Brownsville, TX 78521

Personal Information

First name

Middle name

Maiden name

Last name

Date of birth

mm/dd/yyyy

Social security no.

Hire date

mm/dd/yyyy

Telephone number

E-mail address

Address

Street

City

State

Zip code

How long

Previous three years residency

Last residency

Second last residency

Third last residency

CDL information

Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver's license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.

State

License no.

Type

Expiration date

mm/dd/yyyy

Driving experience

With experience

No experience

Accident record

Accident record for past 3 years or more

Yes

Traffic convictions and forfeitures

Traffic convictions and forfeitures for the past 3 years

Yes

Other

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

B. Has any license, permit or privilege ever been suspended or revoked?

Yes

C. Have you worked in this company or in a sister company before?

Yes

D. How did you find out about this position?

Explain

Employment record

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).

With experience

No previous jobs

Authorizations

I authorize you to make sure investigations and inquiries to 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 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:

Digital signature (type your name)