Have you ever worked for this company under another name?

Are you applying as a company driver or an owner operator?

Are you currently employed?

When are you available to start work for this Company?

How long are willing to be away from home?

How much home time will you need when you return?

How many miles or hours are you expecting per week?

How much do you expect to make per week (gross)?

If not, how long since leaving last employment?

Last school attended

Last Employer

Second Last Employer

Third Last Employer

Forth Last Employer

Do you currently hold more than one valid license?

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

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

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Reg’s?

Accident Review for past 3 years:

Motor Vehicle Laws & Ordinances

EXPERIENCE

Applicant: Read and sign before submitting this application.

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty and reason for non-consideration or subsequent dismissal if hired or denial of authorization to drive. It is also agreed and understood that the motor carrier or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his/her furnishing such information. I understand that nothing contained in this application or in the granting of any interview or a road test is intended to create an employment contract between this company and myself, for either employment, authorization to driver, or for the providing of any benefits. I agree to furnish such additional information that may be necessary and complete such examinations as may be required to complete my application file including but not limited to a pre-employment negative urine test and successful completion of a human performance evaluation including a Department of Transportation Physical. No promises regarding employment or authorization to drive have been made to me, and no such promises exist unless specifically made by this Company in writing. It is agreed and understood that if qualified, hired or contract started, I may be on a probationary period during which time I may be disqualified without recourse. I understand employment or authorization to drive with this carrier is on an “at-will” basis that allows me to quit, be fired, or lease agreement revoked at any time with or without notice and with or without cause. 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. *I understand that all employment related language, including but not limited to “employer”, “employee”, and “employment” are used in conjunction with the requirements specified in FMCSR 391 and is not being construed as an offer of employment.

DISCLOSURE STATEMENT

Applicant: Read and sign before submitting this application.

By this document,
Grafton Transit discloses to you that a consumer report, including an investigative report containing information as to your character, general reputation, personal characteristics, driving record, and mode of living may be obtained for qualification purposes as part of the pre-qualification background investigation and at any time during your relationship with the motor carrier. Should an investigation consumer report be requested you have the right to demand a complete and accurate disclosure of the nature and scope of the investigation requested and a written summary of your rights under the Fair Credit Reporting Act. Please sign below to signify receipt of the foregoing disclosure.