Please fill out the following application and press the "Submit" button at the bottom of the page.
* are required.
Personal Information
* First Name:
* Last Name:
* Date of Birth:
/
/
* Social Security Number:
* Address:
* City:
* State:
* Zip Code:
Contact Information
* Phone:
E-mail Address:
* Best Time to Call:
Driving Information
* Have you attended a professional driver training school?
School Name:
When?
Naval Service or US Military:
Type of discharge:
Presently a member of the National Guard or Reserves?
* I Am Now A
Owner Operator Company Driver
* Years Driving Experience
* Commercial Driver License No.:
* State Issued
* Exp. Date: /
/
* Class:
A B C
Endorsements: Hazmat
Tanker
Double/Triple
* Experienced Driving:
Van
Flatbed
Tanker
Reefer
Hazmat
Double/Triple
List all motor vehicle accidents in which you were involved during the past five (5) years, regardless of fault, specifying the date and nature of each accident and any fatalities or personal injuries involved.
Date:
Nature of Accident:
Location:
Injuries or Fatalities:
Date:
Nature of Accident:
Location:
Injuries or Fatalities:
Date:
Nature of Accident:
Location:
Injuries or Fatalities:
List all violations of motor vehicle laws or ordinances(other then parking) of which you were convicted or forfeited bond during the past five (5) years.
Date:
Type of Violation:
Place Where Violation Occured:
Date:
Type of Violation:
Place Where Violation Occured:
Date:
Type of Violation:
Place Where Violation Occured:
* Have you ever been denied the issuance of a license to operate a motor vehicle, or have you ever had a license to drive a motor vehicle revoked or suspended?
If you answered "Yes", explain in detail the facts and circumstances.
* How many chargeable and non-chargeable accidents in the last 3 years?
Employment Information
Present Employer Fill out this section only if currently employed as a professional driver.
Start:
/
/
Company:
Phone Number:
Address:
City:
State:
Zip Code:
Previous Employer #1
* Start:
/
/
* End:
/
/
* Company:
* Phone Number:
* Address:
* City:
* State:
* Zip Code:
Previous Employer #2
Start:
/
/
End:
/
/
Company:
Phone Number:
Address:
City:
State:
Zip Code:
Previous Employer #3
Start:
/
/
End:
/
/
Company:
Phone Number:
Address:
City:
State:
Zip Code:
Criminal Record Information - If Any
* Have you ever been convicted of a felony?
No Yes Date:
* Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof?
No Yes Date:
* Have you ever been denied a license, permit or privilege to operate a motor vehicle?
No Yes Date:
* Has any license, permit or privilege ever been suspended or revoked?
No Yes Date:
* Have you ever been convicted, or are any charges pending, for reckless or careless operation of a motor vehicle?
No Yes Date:
* Have you ever been convicted, or are any charges pending, for possession, sale or use of a narcotic drug, amphetamines, or derivatives thereof?
No Yes Date:
* Have you ever been refused any type of insurance or been denied bonding?
No Yes Date:
* Have you ever been discharged or suspended?
No Yes Date:
Comments
DAC Release
By submitting this application I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Wooster Motorways Inc. and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from DAC Services. DAC is a consumer reporting agency. Any decision they make not to hire you based on information contained in your consumer report will be their decision alone. DAC does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies them selves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report.Your consent for these companies to obtain the report from DAC is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.
* I have read the above release and I give permission to obtain consumer reports about me from DAC.
