EQUAL OPPORTUNITY EMPLOYER

Drug Transport, Inc. Employment Application

It is the policy of Drug Transport to provide employment opportunities without regard for race, color, religious creed, national origin, sex, disability or ancestry.  Also, the age discrimination act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40.

DRUG TRANSPORT, INC 1939 Forge Street Tucker, GA 30085 Terminal


(last) (first) (middle)
Name:


 

Phone:   Social Security No.

(street) (city) (apt.) (state) (zip)
Current Address:

If at the above address less than three years, list all addresses for the past three years.
(street) (city) (state) (zip)
1.
2.
3.

Date of birth:(answer only if applying for a driving position)

(name) (address) (phone)
In case of emergency notify:

Position applying for:    Temporary or Full-time:

Have you worked for this company before?  Where?

Dates:  From  To  Rate of pay:  Position:

Reason for leaving:

Names of relatives in our employ:

Are you now employed?  If not, how long since leaving last employment?

Who referred you? Rate of pay expected: 

Date you can start:

Ability Inquiry

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accomodation? (yes/no)

If you need reasonable accomodation, please describe the type of reasonable accomodation you need:

Are you currently holding a valid DOT certified commercial driver's license? (Yes/No)

Military Service

Dates served:  From To   Branch:

Last rank held:  Reserve status (active/inactive): until date:

Education

Select highest grade level completed:  High School:  Years of College:
Last School Attended
Name of school:
address of school:

General

Are you legally eligible to work in the U.S. (yes/no) (Proof of legal right to work in this country will be required upon employment.)

Have you ever been convicted of a felony (yes/no) 

           If yes, explain fully:

Have you in the past five years been convicted of a misdemeanor or are you presently formally charged with committing a criminal offense? (Conviction of a crime will not necessarily disqualify you from employment.)

Experience and qualifications--Driver

Driver licenses held in the last 3 years.  Must be shown.
State License No. Type Endorsements Expiration date

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

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

C.  Have you ever been disqualified subject to section 391.15 of the Federal Motor Carrier Safety Regulations?

    If the answer to either A, B, or C above is "yes", give details:
   

Driving Experience

Class of equipment:

Type of equipment
(van, tank, flat, etc)

Date from Date to Approx No. of Miles
(Total)
Straight Truck
Tractor and semi-trailer
Twin-trailers
Other

List states operated in for last five years:

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

Which safe driving awards do you hold and from whom?

Accident Review for Past 3 Years

Dates

Nature of accident
(head-on, rear-end, upset, etc)
Fatalities Injuries
Last accident:
Next previous:
Next previous:

Traffic convictions and forfeitures for the past 3 years (other than parking violations)
Location Date Charge Penalty

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. 
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 vehicle.

  *includes vehicles having a GVWR of 26,001 lbs or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.


(Note: List employers in reverse order starting with the most recent.)

Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:


Employer

Name:
Address:
City: State: Zip:
Phone number:

Dates

From
Mo. Yr.

To
Mo. Yr.

Position Held:

Reason for leaving:

References

Give name, address and telephone number of three references who are not related to you and are not previous employers.
Name Address Business Telephone No.
1.
2.
3.

Any other information you feel would be helpful in our consideration of your application:

Please read the following. If you have any questions about our conditions for employment, please contact us before clicking the "Submit Application" button below.

I understand that my employment is dependent upon: (1) Completing a DOT physical examination, (2) abiding by company rules and regulations, and (3) successful completion of a probationary period for at least 90 days.
Information furnished in this application or obtained as a result of any inquiry will not necessarily preclude employment but will be used as part of an overall evaluation of my qualifications.
Pursuant to the provisions of the Fair Credit Reporting Act, I hereby acknowledge notification that an inquiry may be requested to procure information relating to my character, general reputation, personal characteristics and mode of living and that if such request is made, the nature and scope of the inquiry will be provided to me upon written request.  In connection with any inquiry that may be requested, I hereby authorize all public and private individuals, courts and law enforcement agencies, corporations, organizations, firms, institutions and agencies who possess information about me, to release to any Drug Transport employee or any representative thereof, without liability, any and all information concerning my background and personal history, and allow copies to be made of any requested written data.
As a condition of employment, I will never illegally use, possess, or divert control drugs and/or marijuana or any other illegal substance.  I am aware that a violation of this condition will result in the immediate termination of my employment. 
I understand that if I am extended a conditional job offer, it is contingent upon the results of a medical review.  I understand that a job offer can be rescinded if, according to reasonable medical judgment, I cannot perform the essential functions of the job, or if I pose a threat to the health or safety of myself or others in the workplace.  The results of this medical review will be used only in a manner consistent with job-relatedness and business disclosures.  I also understand that any medical omission or falsification will be grounds for discharge. 
I also understand that I shall be subject to immediate dismissal if any of the information I have given is false, or if I have failed to give any material information requested.
Nothing contained in this application is intended or should be construed to create any contractual or other legal obligation between Drug Transport and its employees or to limit the right of Drug Transport or its employees from terminating the employment relationship, at any time, without restriction.
Clicking the Submit Application button below 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.


Thank you for your interest in our company. You can be assured that our review of your job qualifications will be based solely on merit.