Apply - United Tran Services, Inc.

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or non-job related disability. Please answer ALL questions. Do not leave any item blank. Use “No”, “N/A” or “None” if applicable.

General

Tell us about yourself.

Last Name

First Name

Middle Name

Ssn

Date of Birth

Truck Driving Position Applying for:

Full Time

Part Time

How did you hear about us?

Have you ever worked for United Trans Services INC?

Driver Licenses

State	License Number	Type	Endorsements	Expiration Date

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

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

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

List each type of commercial motor vehicle you have operated and for how long

Class of Equipment	Type of Equipment	From	To	Approximate Miles

List states operated in during the last 5 years:

List special courses or training completed:

List safe driving awards and who presented the awards:

Accident Record for the past 3 years. List each vehicle accident or any incident regarding damage to a vehicle or personal property in which you were involved during the past three years preceding the date of this application. Indicate the date, type of vehicle and circumstances of each accident/incident and whether any personal injuries or fatalites were involved.

Accident Date	Type of Vehicle	Nature of Accident	Location of Accident	# of Fatalities	# of Injuries

Traffic Convictions and Forfeitures for the last 3 years (other than parking violations) of which you were convicted, forfeited bond, or collateral during the three years preceding the date of this application.

Location	Date	Charge	Penalty

Addresses

List current address and all addresses at which you have resided during the past 10 years.

Contact Details

Home Phone #

Cell Phone #

Emergency Contact Name

Emergency Contact #

Education

High School Attended

City

State

Graduated?

College/Trade School Attended

City

State

Graduated?

Driving School Attended

City

State

Completion Date

Background

Have you ever been conviced of a felony?

Have you ever been conviced of/or have a pending DWI/DUI?

Are you authorized to work in the United States?

Employment Record

In accordance with FMCSR 391.21 & .23, an applicant must list all previous work experience for the three (3) years prior to the date of the application shown on page one, as well as all commercial driving experience for the seven (7) year period prior to those three years, for a total of 10 years . Include your job description, date of employment, reason for leaving and whether you were subject to FMCSA & U.S. DOT alcohol and controlled substance testing requirements for each job listed. Please start with the most recent employer. Include self-employment or time leased to another carrier. Use an additional sheet if needed. Any gaps in employment (including unemployment or retirement) must be explained.

Please start with the most recent employer.

Employer

From

Address

City

State

Zip

Telephone Number

Fax Number

Equipment Operated

Materials Hauled

Position Held

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?

Were you subject to the US DOT alcohol and controlled substances testing requirements?