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.
Phone: Social Security No.
Date of birth:(answer only if applying for a driving position)
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:
Are you able to perform the essential functions of the job for
which you are applying with or without reasonable
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)
Dates served: From To Branch:
Last rank held: Reserve status (active/inactive): until date:
Select highest grade level completed:
Years of College:
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)
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
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
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
Type of equipment (van, tank, flat, etc)
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
Traffic convictions and forfeitures for the past 3 years (other
than parking violations)
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
employers in reverse order starting with the most recent.)
Give name, address and telephone number of three references who
are not related to you and are not previous employers.
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
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
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.