347x140

1701 South Delmar Ave
PO Box 68
Hartford,IL 62048
Phone (618) 254-2514

Driver Application (* denotes required field)

*First Name

* Last Name

*Present Address

*City, State and Zip

Date of Birth

*Social Security Number

Daytime Phone

Best Way to Be Reached

Cell Phone

Best Time to Be Reached

Email Address

Expected Date of Availability

Driver’s Information and Experience (*required fields)

*Driver’s License Number

*Driver’s License State Issued

*Years of Recent Driving Experience

*Number of Accidents Last 3 Yrs.

*License Revoked, Suspended or Neither

*Driver’s License Class

*Driver’s License Exp. Date

*Endorsements Acquired

*Number of Moving Violatons Last 3 Yrs.

*Cited for DUI, DWI or Neither

*If Cited for DUI, DWI, how many years ago?

*Convicted of a Misdemeanor?

Position Desired (pick one)

Over the Road Driver

Local Truck Driver

*Convicted of a Felony?

Other

If other, exlpain

Current or Last Employer (all fields required)

Company

Telephone

From

To:

Address

Supervisor

City, State and Zip

Type of Trailer or Vehicle

Reason For Leaving

Previous Employer (all fields required)

Company

Telephone

From

To:

Address

Supervisor

City, State and Zip

Type of Trailer or Vehicle

Reason For Leaving

Previous Employer (all fields required)

Company

Telephone

From

To:

Address

Supervisor

City, State and Zip

Type of Trailer or Vehicle

Reason For Leaving

Previous Employer (all fields required)

Company

Telephone

From

To:

Address

Supervisor

City, State and Zip

Type of Trailer or Vehicle

Reason For Leaving

Previous Employer (all fields required)

Company

Telephone

From

To:

Address

Supervisor

City, State and Zip

Type of Trailer or Vehicle

Reason For Leaving

I, as an applicant, understand that by submitting this form, I certify that it was personally completed and that all present information is true and correct. This driver authorizes any company that receives this application to cause to be conducted, at any time, to an investigation of presented background for employment purposes, which may include, but is not limited to, any information related to 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 which may reflect upon potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. All applicants certify that they have completed this form of their own free will and hold Schiber Truck Company Inc. harmless of all liability for providing it.

1701 South Delmar Ave PO Box 68 Hartford, IL 62048
Phone (618) 254-2514  Fax (618)254-6057   Email

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