Driver Application

Fields marked with a * MUST be filled in.

PERSONAL INFORMATION
Name:
 *
Address: Last Three Years
Address 1:
 *
City:
 *
State:
 *
Zip:
 *
 
Address 2:
City:
State:
Zip:
 
Address 3:
City:
State:
Zip:
 
Phone:
 *
Cell Phone:
 *
E-mail:
 *
Date Of Birth:

*
Social Security #:

*
Preferred method of contact:
 Phone Cell Phone Mail E-mail *
Position Applying For:
 
  DRIVERS LICENSE DETAILS
License Number:
 *
Type:
 *
State Of Issue:
 *
Expiration Date:
 *
Additional License:
License Number:
Type:
State Of Issue:
Expiration Date:
License Number:
Type:
State Of Issue:
Expiration Date:

  DRIVING RECORD
Number of tickets in last three (3) years
 *
Number of accidents in last three (3) years
*
Have you ever been arrested for driving while intoxicated?
 Yes No *
If yes, please list date.
Have your ever had your license suspended or revoked?
 Yes No *
If yes, please list date.

  DRIVING EXPERIENCE
Class of Equipment

Type of Equipment (Van, tank, flat, etc.)

Dates

From: To:

Approx. No. of Miles (Total)

Straight Truck
Tractor and Semi-Trailer
Tractor - Two Trailer
Other

  EMPLOYMENT HISTORY
Current / First Previous Employer or other related experience
  
Start Date:
 *
Finish Date:
 *
Hourly Rate/Salary:
*
Supervisor Name :
 *
Work Performed :
 *
Employer Name:
 *
Employer Address:
 *
Employer City:
 *
Employer State:
 *
Employer Phone:
 *
Type of Trailers:
 *
State/areas covered:
While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations?:
 Yes No *
Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes No *
Reason For Leaving:

Second Previous Employer
 
Start Date:
Finish Date:
Hourly Rate/Salary:
Supervisor Name :
Work Performed :
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Phone:
Type of Trailers:
State/areas covered:
While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations?:
 Yes No
Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes No
Reason For Leaving:

Third Previous Employer
 
Start Date:
Finish Date:
Hourly Rate/Salary:
Supervisor Name :
Work Performed :
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Phone:
Type of Trailers:
State/areas covered:
While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations?:
 Yes No
Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes No
Reason For Leaving:
Comments:

Please enter any comments or additional information you may have here:

I understand that the information in this application, including past employment information, will be used and that prior employers will be contacted for purposes of investigating my safety performance history information as required by paragraphs (d) and (e) of CFR 49 Part 391.23. I also understand that I have the following rights regarding the investigative information that will be provided to Royal Logistics. 1) the right to review information provided by previous employers; 2) the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to Royal Logistics; 3) the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information. In order to review previous employer-provided investigative information I must submit a written request to Royal Logistics, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment, Royal Logistics will provide this information to me within five business days of receiving my written request. If Royal Logistics has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when Royal Logistics receives the requested safety performance history information. If I have not arranged to pick up or receive the requested records within thirty (30) days of Royal Logistics, Making them available, Royal Logistics may consider me to have waived my request to review the records. I am aware that a consumer report (motor vehicle record) will be obtained on me in the course of consideration for employment and at any time through out my employment. I hereby authorize, without reservation, Royal Logistics to periodically receive my driving record, and such authorization will remain in effect for one year or for the duration of employment or contract between the company and employee/contractor, whichever period is longest. I also understand that misrepresentation or emission of information or facts may results in my rejection or dismissal. 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.