Drivers Application

APPLICANT INFORMATION

First Name *

M.I.

Last Name *

Phone *

Email *

Date of Birth

(Required for Commercial Drivers)

Can you provide proof of age?

Yes

No

Do you have the legal right to work in the United States? *

Yes

No

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, explain if you wish.

Position Applied for: *

Date available to start *

Rate of pay expected *

Were you refered to 2Gates Trucking LLC by anyone?

Yes

No

Who refered you? *

Have you ever been bonded?

Yes

No

Answer only if a job requirement)

Name of bonding company: *

Have you ever worked for 2Gates Trucking LLC or any of its subsidiaries or partners? *

Yes

No

Where? *

Dates: From *

Dates: To *

Rate of Pay: *

Position: *

Reason for leaving *

ADDRESS INFORMATION

List your addresses of residency for the past 3 years. List your Current Address first, use the "Add Address" button to add additional residency addresses.

Street Address *

Apartment / Unit #

City *

State *

ZIP *

How Long? *

yr./mo.

Add Address Remove Address

EMPLOYMENT HISTORY

Are you currently employed? *

Yes

No

How long since leaving your last employment? *

All driver applicants to 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 vehicles.

NOTE: List employers in reverse order starting with the current /most recent. Click the "Add Employer" button to add additional employment history.

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including driver), or any size vehicle used to transport hazardous material in a quantity requiring placarding.

Company Name *

Address *

City *

State *

ZIP Code *

Contact Person *

Phone Number *

Were you subject to FMCSRs* while employed? *

Yes

No

*The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in the interstate commerce to transport passengers or property when a vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug & alcohol testing requirements of 49 CFR 40? *

Yes

No

From *

To *

Position Held

Starting Salary $

Ending Salary $

Responsibilities

Reason for Leaving *

May we contact your previous supervisor? *

Yes

No

Add Employer Remove Employer

ACCIDENT RECORDS

Have you had any accidents in the past 3 years? *

Yes

No

ACCIDENT RECORD DETAILS

Accident records for the past 3 years are required. Click the "Add Accident" button to add an additional accident details.

Date of accident *

Nature of accident (Head-on, Rear-end, Upset, Etc.) *

Fatalities *

Yes

No

Injuries *

Yes

No

Hazardous Material Spill *

Yes

No

Add Accident Remove Accident

TRAFFIC CONVICTIONS & FORFITURES

Have you had any traffic convictions or forfeitures (other than parking violations) in the past 3 years? *

Yes

No

TRAFFIC CONVICTIONS & FORFITURES DETAILS

Traffic convictions or forfeitures (other than parking violations) for the past 3 years are required. Click the "Add Traffic Convictions or Forfeitures" button to add an additional convictions or forfeitures details.

Location *

Date of convictions or forfeitures *

Charge *

Penalty *

Add Traffic Convictions or Forfeitures Remove Traffic Convictions or Forfeitures

LICENSES & PERMITS

List any drivers license or permits held in the past 3 years. Click the "Add License or Permits Details" button to add an additional drivers license or permits details.

State

License or Permit Number

Class

Endorsement(s)

Expiration Date

Add License or Permits Details Remove License or Permits Details

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

Yes

No

Explain why you where denied. *

Has any license, permit or privilege to operate a motor vehicle been suspended or revoked? *

Yes

No

Explain why you where suspended or revoked. *

DRIVING EXPERIENCE

Straight Truck *

Yes

No

From Date

To Date

Total Number of Miles Experience

Tractor & Semi-Trailer *

Yes

No

From Date

To Date

Total Number of Miles Experience

Tractor - Two Trailers *

Yes

No

From Date

To Date

Total Number of Miles Experience

Tractor - Three Trailers *

Yes

No

From Date

To Date

Total Number of Miles Experience

Motorcoach - School Bus (More than 8 passengers) *

Yes

No

Type of Equipment

From Date

To Date

Total Number of Miles Experience

Motorcoach - School Bus (More than 15 passengers) *

Yes

No

Type of Equipment

From Date

To Date

Total Number of Miles Experience

Other

Type of Equipment

From Date

To Date

Total Number of Miles Experience

List states operated in for the past five years: *

Show special courses or training that will help you as a driver:

Which Safe Driver Awards do you hold and from whom?

Show any trucking, transportation or other experience that may help you in your work for 2Gates Trucking LLC.

List any special equipment or technical materials you can work with (other than those already shown).

EDUCATION

Selected the highest grade completed.

Last School Attended

Name of High School *

Location (City & State) *

Name of College (If Applicable)

Location (City & State)

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my persona, 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:

• Review information provided by previous employers;

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

I certify that this application was completed by me, and that all entries on it and the information in it are true and complete to the best of my knowledge.

Signature *

Clear

Drivers Application