Driver's Application for Employment

Wylie Wilson Trucking, Inc.
27319 Highway 61
Red Wing, MN 55066

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, or non-job related disability.

* required fields for commercial drivers.

Position(s) Applied for:

Personal Information


First Name:* Middle Name: Last Name:* Address: City: State: Zip: Duration Lived Here: Email:* Mobile Phone: Home Phone: Social Security Number: Date of Birth:*
Can you provide proof of age? YesNo
Available Start Date:

All Previous Addresses of Residency During the Past Three Years

Most Recent Previous Residence

Address: City: State: Zip: Duration Lived Here:

Second Most Recent Previous Residence

Address: City: State: Zip: Duration Lived Here:

Third Most Recent Previous Residence

Address: City: State: Zip: Duration Lived Here:

Employment Details


Have you ever worked for this company before?: YesNo
If "Yes"
From:
To:
Position: Wage: Reason for Leaving:
Are you employed now? YesNo
If "No", when were you last employed?
Referred By: Wage Sought:
Are there any reasons why you might be unable to perform the functions of the job for which you have applied? YesNo
If "yes", explain below if you wish to do so.

Employment and Driving History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three years. For each, 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 seven years of information on those employers for whom the applicant operated such vehicles.This includes vehicles having a GVWR of 26,001 pounds or more, vehicles designed to transport fifteen or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Most Recent Employer

Employer: Address: City: State: Zip: Phone: Job Title: Supervisor's Name: Reason for Leaving:
Start Date:
End Date:
Work Performed:
Salary/Wage:
May we check references? YesNo

Second Most Recent Employer

Employer: Address: City: State: Zip: Phone: Job Title: Supervisor's Name: Reason for Leaving:
Start Date:
End Date:
Work Performed:
Salary/Wage:
May we check references? YesNo

Third Most Recent Employer

Employer: Address: City: State: Zip: Phone: Job Title: Supervisor's Name: Reason for Leaving:
Start Date:
End Date:
Work Performed:
Salary/Wage:
May we check references? YesNo

Fourth Most Recent Employer

Employer: Address: City: State: Zip: Phone: Job Title: Supervisor's Name: Reason for Leaving:
Start Date:
End Date:
Work Performed:
Salary/Wage:
May we check references? YesNo

Fifth Most Recent Employer

Employer: Address: City: State: Zip: Phone: Job Title: Supervisor's Name: Reason for Leaving:
Start Date:
End Date:
Work Performed:
Salary/Wage:
May we check references? YesNo

Accident Record


List all of the accidents you have been in from the last three years.

Most Recent Accident

Date: Nature of Accident: (head-on, rear-end, upset, etc.) Number of Fatalities: Number of Injuries:

Second Most Recent Accident

Date: Nature of Accident: (head-on, rear-end, upset, etc.) Number of Fatalities: Number of Injuries:

Third Most Recent Accident

Date: Nature of Accident: (head-on, rear-end, upset, etc.) Number of Fatalities: Number of Injuries:

Traffic Convictions


List all traffic convictions or forfeitures from the past three years.

Most Recent Traffic Conviction

Location: Date: Charge: Penalty:

Second Most Recent Traffic Conviction

Location: Date: Charge: Penalty:

Third Most Recent Traffic Conviction

Location: Date: Charge: Penalty:

Education & Experience


High School

Name: Address: City: State: Zip:
Graduated?: YesNoIn Progress
Degree:

Business, Trade, or Technical School

Name: Address: City: State: Zip:
Graduated?: YesNoIn Progress
Degree:

College, Undergraduate

Name: Address: City: State: Zip:
Graduated?: YesNoIn Progress
Degree:

College, Graduate

Name: Address: City: State: Zip:
Graduated?: YesNoIn Progress
Degree:

Other Education

Name: Address: City: State: Zip:
Graduated?: YesNoIn Progress
Degree:

Driver Licences


Driver Licence 1

State: License Number: Type: Expiration Date:

Driver Licence 2

State: License Number: Type: Expiration Date:

Driver Licence 3

State: License Number: Type: Expiration Date:
Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo
Has any license, permit or privilege ever been suspended or revoked? YesNo
If "Yes" answered for either of the above, please explain below.

Driving Experience


Straight Truck

Type of Equipment: (van, tank, flat, etc.) Approximate Miles: From: To:

Tractor & Semi-Trailer

Type of Equipment: (van, tank, flat, etc.) Approximate Miles: From: To:

Tractor & Two Trailers

Type of Equipment: (van, tank, flat, etc.) Approximate Miles: From: To:

Motor Coach & School Bus

Type of Equipment: (van, tank, flat, etc.) Approximate Miles: From: To:

Other

Type of Equipment: (van, tank, flat, etc.) Approximate Miles: From: To: List states operated in during the last five years. List and describe special courses or training completed that will help you as a driver. What save driving awards do you hold and from whom? Please list any trucking, transportation or other experience that may help in your work for this company. List courses and training other than those shown elsewhere in this application. List any special equipment or technical materials you can work with (other than those already shown).

Attachments

If you have additional information no covered elsewhere, please save your information into a document and attach it here. 1. Attachments should be .DOC, .DOCX, .PDF, .RTF, or .TXT and not larger than 100k. 2. Make sure that your full name is in the file name -- e.g., "Work History - John Doe.doc".

Applicant's Statement

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 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 have read and understood the Applicant's Statement.

Fair Credit Reporting Act Disclosure Statement

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations. I have read and understood the Fair Credit Reporting Act Disclosure Statement.