670 Allen Road, Carlisle, PA 17015 • 717-258-3040 • info@allendistribution.com 
 

CDL Driver Employment Application

Our on-line application is not a substitution for a formal job application or employment interview, but merely a starting point to match your skills and previous work experiences to any currently available positions at Allen Distribution.

Click Here to download our General Employment Application or Fill out the Online Form below.


DRIVER'S APPLICATION FOR EMPLOYMENT
Applicant Name:
Date:
Company:
Address:
City:
State:
Zip:
E-mail Address: *
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Initials:   *             Date:  
TERMINATION OF EMPLOYMENT
Date terminated:
Department released from:
Dismissed:
Voluntarily quit:
Other:
Termination report placed in file:
Supervisor:
APPLICANT TO COMPLETE
Position(s) applied for:
First Name:   Middle Initial:    Last Name:  
Social Security Number:
List your addresses of residency for the past (3) years:
Current Address:
Street:  City:  State:  Zip: 
Phone:  How long?
Previous Address [1]:
Street:  City: State/Zip:
How long?
Previous Address [2]:
Street: City:  State/Zip:  
how long?
Previous Address [3]:
Street: City:  State/Zip:  
How long?
Do you have the legal right to work in the United States? Yes No
Date of Birth:         (Required for Commercial Drivers)
Can you provide proof or age? Yes No
Have you worked fro this company before? Yes No
Where?
Dates: From: To:
Rate of Pay:
Position:
Reason for leaving?
Are you now employed? Yes No
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected:
Have you ever been bonded? Yes No        (Answer only if a job requirement)
Name of bonding company:
Have you ever been convicted of a felony? Yes No
If yes, please explain fully on a separate piece of paper. Conviction of a crime is not an authentic bar to employment – all circumstances will be considered.
Is there any reason you might be unable to perform the functions of the job for which you have applied? Yes No
If yes, explain if you wish:
EMPLOYMENT HISTORY
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

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.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
Employer Name [1]:
Address:
City: State:  Zip: 
Contact Person: Phone: 
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
Employer Name [2]:
Address:
City: State: Zip:
Contact Person: Phone:
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
Employer Name [3]:
Address:
City: State: Zip:
Contact Person: Phone:
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
Employer Name [4]:
Address:
City: State: Zip:
Contact Person: Phone:
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
Employer Name [5]:
Address:
City: State: Zip:
Contact Person: Phone:
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
Employer Name [6]:
Address:
City: State: Zip:
Contact Person: Phone:
Dates: From: To:
Position Held:
Salary/Wage:
Reason for leaving:
Were you subject to the FMCSRs† while employed? Yes No
Was your job designated as a safety-sensitive function in any dot-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40? Yes No
*
 Includes vehicles having a GVWR of 26,0001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
†
 The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,0001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
ACCIDENT RECORD
FOR PAST 3 YEARS OR MORE. IF NONE, WRITE NONE.
Date: [Last Accident]
Nature of Accident: (Head-on, Rear-end, Upset, etc.)
Fatalities:
Injuries:
Hazardous Material Spill:
Date: [Next Previous 1]
Nature of Accident: (Head-on, Rear-end, Upset, etc.)
Fatalities:
Injuries:
Hazardous Material Spill:
Date: [Next Previous 2]
Nature of Accident: (Head-on, Rear-end, Upset, etc.)
Fatalities:
Injuries:
Hazardous Material Spill:
TRAFFIC CONVICTIONS AND FORFEITURES
FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS). IF NONE, WRITE NONE.
Location: [1] Date:
Charge: Penalty:
Location: [2] Date:
Charge: Penalty:
Location: [3] Date:
Charge: Penalty:
EXPERIENCE AND QUALIFICATIONS - DRIVER
List all driver licenses or permits held in the past 3 years
State: [1] License Number:
Type: Expiration Date:
State: [2] License Number:
Type: Expiration Date:
State: [3] License Number:
Type: Expiration Date:
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
B. Has any license, permit or privilege evern been suspended or revoked? Yes No
If the answer to either A or B is YES, give details:
DRIVING EXPERIENCE
Class of Equipment - Straight Truck: Yes No
Equipment Type: Van Tank Flat Dump Reefer
Date - From: To:
Approximate Number of Miles: (total)
Class of Equipment - Tractor and Semi-Trailer: Yes No
Equipment Type: Van Tank Flat Dump Reefer
Dates - From: To:
Approximate Number of Miles:
Class of Equipment - Tractor - Two Trailers: Yes No
Equipment Type Van Tank Flat Dump Reefer
Dates - From: To:
Approximate Number of Miles:
Class of Equipment - Tractor - Three Trailers: Yes No
Equipment Type: Van Tank Flat Dump Reefer
Dates - From: To:
Approximate Number of Miles:
Class of Equipment - Motorcoach - School Bus: [More than 8 passengers] Yes No
Equipment Type:
From: To:
Approximate Number of Miles:
Class of Equipment - Motorcoach - School Bus: [More than 15 passengers] Yes No
Equipment Type:
From: To:
Approximate Number of Miles:
List states operated in for last 5 years:
Show special courses or training that will help you as a driver:
Which safe driving awards do you hold and from whom?
EXPERIENCE AND QUALIFICATIONS - OTHER
Show any trucking, transportation or other experience that may help in your work for this company:
List courses and training other than shown elsewhere in this application:
List special equipment or technical materials you can work with (other than those already shown):
EDUCATION
Select highest grade completed: 1 2 3 4 5 6 7 8 9
High School: 1 2 3 4
College: 1 2 3 4
Last school attended:
City/State:
TO BED READ AND SIGNED BY APPLICANT
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.
Initials: *             Date:
 
               
2008 Copyright © Allen Distribution. All Rights Reserved. Designed by Green T Design. [Print this page]