Apply for Truck Driver Class A CDL - OTR

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Summary
Title:Truck Driver Class A CDL - OTR
ID:1079
Division:Transportation
Resume
Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Applicant Data Record

As employers/government contractors, we comply with government and affirmative action responsibilities.

To help us comply with government record keeping, reporting and other legal requirements, we would appreciate your cooperation in completing the Applicant Data Record.

This data is for periodic government reporting only and will be kept CONFIDENTIAL. This Data Record will be kept separate and will not be considered a part of your Application for Employment.

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PLEASE PRINT ALL INFORMATION

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Date::
Position(s) Applied For(must specify specific position)::
Referral Source::
Advertisement
College Recruit
Walk-In
Internet
Employment Agency
Company Contacted
Employee Referral
Internal Posting
Job Service
Mail
Professional Association
Other Referral Source::

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* Name::
Address::
Phone Number::

AFFIRMATIVE ACTION SURVEY

D.L. George & Sons is subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite you to voluntarily self-identify your race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulation, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Check those that apply::
Male
Female
White
Hispanic or Latino
Asian
Black/African American
American Indian/Alaskan Native
Native Hawaiian or other Pacific Islander
Two or more races, Please list those races::
Driver application
PERSONAL INFORMATION
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 the presence of a non-job related medical condition or handicap.

* Date of Birth:
* Can you provide proof of age?:
Yes   No
* SSN#:
* Are you a U.S. Citizen?
Yes   No
* Can you read, speak, and write in English fluently?
Yes   No
* Years at Current Residence?:
If '5+ Years' was NOT selected for the previous question, please list your address prior to your current address:
* Can we text you regarding future opportunities?:
Yes   No
* Highest Level of Education
In case of emergency notify: (include Name and Phone number)
* Have you ever worked for this company before?
Yes   No
If yes to the above question, where and when?
If previously employed here, what position did you hold, and rate of pay?.
Reason for leaving:
* Are you employed now?
Yes   No
If not, how long since leaving last employment
Who referred you?
Rate of pay expected:

PHYSICAL HISTORY
List any handicap that prevents you from doing certain kinds of work:
* Are you physically capable of heavy manual work?
Yes   No
* Ever injured on the job?
Yes   No
Give nature and degree of such injuries:
How much time lost from work in the past three years for illness?
* Would you be willing to take a physical examination?
Yes   No

MILITARY SERVICE
* Were you ever in the military?
Yes   No
If no to the above question, please skip to the next section: License & Driving Information.
If yes, what branch?
Start Date:
End Date:
Honorable Discharge?
Yes   No

LICENSE & DRIVING INFORMATION
* License Class:
* Drivers License State:
* Drivers License Number:
* Drivers License Expiration Date:
* Physical Expiration Date:
* Endorsements:
* Hold Ctrl/Cmd to select multiple items
Other Endorsements (If Applicable)
Hazmat Expiration Date (If Applicable):
* Have you held any additional licenses in the last 3 years?
Yes   No
If yes to the above question, please provide the additional license information
* Which of the following do you have experience with?
* Hold Ctrl/Cmd to select multiple items

EMPLOYMENT INFORMATION
All Driver applicants to drive 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 trasport hazardous materials in a quantity requiring placarding
EMPLOYER 1 (Most Recent Employer)

Dates Employed Employer Name & Address Employer Contact Info
From:
*

To:
*
Name:
*

Address:
*
City:
*
State:
*
Zip:
*
Phone:
*

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
*
Yes   No
*
*
# of Days Out on the Road # of States Driven Trailer Length
*
*
*
Reason for leaving? Please Explain: Additional Comments?
*
*
* May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
*
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

Employer 2

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 3

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 4

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 5

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 6

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 7

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 8

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 9

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 10

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 11

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 12

Dates Employed Employer Name & Address Employer Phone & Fax
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain Reason for Leaving Additional Comments?


* Have you been unemployed at any time during the last three (3) years for a period greater than ninety (90) days?
Yes   No
If yes to above question, please provide dates and reason.
TRAFFIC CONVICTIONS
* Do you have ANY traffic convictions within the last 3 years?(Other than parking violations)
Yes   No

TRAFFIC CONVICTION 1

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 2

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 3

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 4

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 5

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC ACCIDENTS
* Do you have ANY vehicle accidents within the last 5 years?
Yes   No

ACCIDENT 1

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes   No

Supporting Documents


ACCIDENT 2

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 3

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 4

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 5

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


EXPERIENCE AND QUALIFICATIONS - OTHER
SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY
Please tell us of any additional relevant experience
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)

CONFIRMATION & SUBMISSION
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. I hereby release employers, schools or persons from all liability in responding to inquiries 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, as permitted by Law.

* Signature:
* Date:

Please enter the last four digits of your Social Security number to confirm your submission:
*

2023 - Voluntary Self-Identification of Disability CC-305
If you choose to complete this form please make sure you include your name at the top.

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1
OMB Control Number 1250-0005
Expires 04/30/2026
Name:
Employee ID:
(if applicable)
Date:

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
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