Driver Application

Use the form below to inquire about driver opportunities with our company.

Step 1 of 4 - Application

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company Named above.

INSTRUCTIONS TO APPLICANT

Please answer all questions. If the answer to any question is "NO" or "NONE", do not leave the item blank - write "NO" or "NONE". THIS IS IMPORTANT!

*The Age Discrimination of Employment Act ofm1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.
Position You Are Applying For?
Applying For..*
- Contractor
- Driver
Choose All that you want to apply for
What Kind of Position*
- Temporary
- Full Time
- Part Time
How Did You Hear About Us?*
- Web Search
- Job Posting
- Someone Referred me
Rate of Pay Expected
Who Referred You?
Your Personal Information
Full Name (First + Middle + Last)*
Permanent Address*
Street Address Address Line 2 City State ZIP Code
Have you Been At this Address less than 3 years?*
- Yes
- No
Previous Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Age*
Date of Birth*
Month
Day
Year
Social Security #*
Other name(s) under which you have been previously employed
General Information
Have you ever applied to this organization before?*
- Yes
- No
If Yes, give date and position applied for*
Do you have any relatives that worked for this company?*
- Yes
- No
Names of friends or relatives employed in this organization
Have you worked for this company before?*
- Yes
- No
If yes, list dates of employment*
MO / YR
Where did you Work?*
MO / YR
Rate of Pay?*
MO / YR
Position?*
MO / YR
Reason for Leaving*
MO / YR
Have you ever been convicted of a felony?*
- Yes
- No
If yes, list dates, offenses, and disposition.
Convictions are not an automatic disqualification from employment.
Education/U.S. Military Service
Where did you attend high school & college? (Click the + button to add a new row)*
School Name & Address Major Years Completed GPA Degree/Diploma
Are you taking any educational course(s) presently?*
- Yes
- No
- I will be soon
If Yes or you will be soon, what and where?
Have you ever served in the U.S. Armed Services?
- Yes
- No
US Military Duties and special training
Rank held at discharge
Employment History
Give a COMPLETE RECORD of all employment for the past three years, including any unemployment or self employment, and all commercial driving experience for the past ten years
Are You Currently Employed?*
- Yes
- No
Company Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Supervisors Name & Title
Job Title
Type of Business
Base Rate of Pay (Hour/Week/Month)*
Dates Employed
From To
Description of duties
May we contact this employer?
- Yes
- No
Employment history the last 3 years -10 years for driving (Click the + button to add a new row)*
Company Name & Address Supervisor Name Position Salary From/To (Mo&YR) Reason you left
Driving Experience
Straight Truck
Dates From Dates To Approximate # of Miles
Tractor & Semi-trailer
Dates From Dates To Approximate # of Miles
Tractor -Two Trailers
Dates From Dates To Approximate # of Miles
Other
Dates From Dates To Approximate # of Miles
List States Operated in for the last five years
List Special Courses/training completed (PTD/DDC, Haz Mat, etc)
List any Safe Driving Awards you hold and from whom
Accident Record for past three years (Click the + button to add a new row)
Date of Accident Nature of Accident (head on, rear end, etc) Location of Accident # of Fatalities # of People Injured
Traffic Convictions and Forfeitures for the last three years (Click the + button to add a new row)
Date Location Charge Penalty
Drivers License for the last three years (Click the + button to add a new row)
State License # Type Endorsements Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
- Yes
- No
Has any license, permit or privilege ever been suspended or revoked?*
- Yes
- No
Have you ever tested positive or refused a DOT drug or alcohol pre employment Test within the past two years from an employer who did not hire you?*
- Yes
- No
If Yes to Any of the above, Please Explain in detail*
References
List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)
Name Address Occupation Years Known
Acknowledgement
Resume Upload (optional)
Accepted file types: doc, pdf, Max. file size: 256 MB.
Would you like to add a cover letter?
- Yes
- No
Cover Letter (optional)
Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 256 MB.
TO BE READ AND SIGNED BY APPLICANT

It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty.

I give the motor carrier and its agents or representatives the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability for damages the motor carrier and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. It is agreed and understood that this application for qualification in no way obligates the motor carrier to employ me.

It is agreed and understood that if qualified to operate motor carrier equipment, I may be on a probationary period, during which I may be disqualified without recourse.

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.
Your Signature*
Use your mouse or finger to sign
Today's Date*
MM slash DD slash YYYY

DISCLOSURE AND RELEASE

In connection with my application for employment (including contract for services) with you, I understand that consumer reports, which may contain public record information, may be requested from DAC Services,Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience , accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc.,from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC SERVICES TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me, which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and Iagree that such information, which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies, which subscribe to DAC services.

I hereby authorize procurement of consumer report(s) . If hired (or contracted), this authorization ion shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
Print Full Name*
Social Security Number
Date Of Birth*
Signature*
Use your mouse or finger to sign
Today's Date*
MM slash DD slash YYYY

DOT/FMCSA Previous Employee Investigations & Inquiries
Name*
First Middle Last
Alias / Maiden Name*
Drivers License #*
Social Security Number
Address*
Same as previous

Street Address Address Line 2 City State ZIP Code
Date of Birth
DOB is being requested in order to obtain accurate records
I hereby authorize the above named company to release any and all information to J&L TRANSPORTATION INC concerning my performance, conduct, accident record and all required DOT drug and alcohol related information while previously employed as a commercial motor vehicle operator in the previous 3 years from the date of this form as specified and required by the Federal Motor Carrier Safety Regulations, Part 391.23 investigation and inquiries. In connection with, and for the duration of my employment (including contract for services) with you, I understand that Investigative background inquires are to be made on myself Including consumer, driving,and other reports. This information will, in whole or in part,be obtained from COTA, A Part of National Compliance Solutions Inc.,1011 Camino Del Rio South, Suite 200, San Diego,CA 888. 908.2382. These reports will Include information as to my work habits, performance and experience along with reasons for termination of past employment from previous employers. Further,I understand that you will be requesting Information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, civil and other experiences as well as claims involving me in the files of insurance Companies. This release may also be used to obtain worker's compensation and education records. By signing below, also acknowledge that I have read and understand the summary of my rights under The fair Credit Reporting Act Pub.L 111-203,H.R.4173.
Your Signature*
Use your mouse or finger to sign
Today's Date*
MM slash DD slash YYYY
The information requested is required by Part 391.23 for the U.S.Department of Transportation Motor Carrier Safety Regulations.
Previous Company Name*
Supervisors Name*
Telephone #*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Period of Employment*
Dates From Dates To Position Held

MANDATORY USE FOR ALL ACCOUNT HOLDERS

IMPORTANT NOTICE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service
1. In connection with your application for employment with J&L TRANSPORTATION INC ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving. and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).
  When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.
  
  When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.
  
  The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing.
  
  If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
2. I authorize J&L TRANSPORTATION INC ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand l may challenge the accuracy of the data by submitting a request to https://dataqs. fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.
4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.
I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Your Signature*
Use your mouse or finger to sign
Today's Date*
MM slash DD slash YYYY
Print Your full Name*
NOTICE: This form is made available to monthly account holders by NICT on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language provided in paragraphs 1-4 of this document to obtain an Applicant's consent. The language must be used in whole, exactly as provided . The language may be included with other consent forms or language at the discretion of the account holder, provided the four paragraphs remain intact and the language is unchanged.

School Name & Address	Major	Years Completed	GPA	Degree/Diploma

From	To

Company Name & Address	Supervisor Name	Position	Salary	From/To (Mo&YR)	Reason you left

Date of Accident	Nature of Accident (head on, rear end, etc)	Location of Accident	# of Fatalities	# of People Injured

Driver Application

Step 1 of 4 - Application

INSTRUCTIONS TO APPLICANT

Position You Are Applying For?

Your Personal Information

General Information

Education/U.S. Military Service

Employment History

Driving Experience

References

Acknowledgement

TO BE READ AND SIGNED BY APPLICANT

DISCLOSURE AND RELEASE

DOT/FMCSA Previous Employee Investigations & Inquiries

MANDATORY USE FOR ALL ACCOUNT HOLDERS

IMPORTANT NOTICE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service