FOX TRANSPORTATION INC
Tide Industrial Park
Tamaqua, Pa 18252
 
Driver Application
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.



First Name
Last Name
Social Security #
Phone #
Date of Birth
E-Mail Address
Position Applied
Rate of Pay Expected

Have worked for
Fox Transportation?

Dates Worked for
Fox Transportation
FROM: Mo/Yr

Dates Worked for
Fox Transportation
TO: Mo/Yr

Worked at
what Location?


Position Held
Rate of Pay?

Reason for Leaving?
Are you now Employed?
If NO, How long since last Employment? Mo/Yr
Ever been Bonded?
What Bonding Co.?


Have you ever been
Covicted of a Felony?

IF YES
Please Explain
Conviction of a Crime is not an automatic bar to employment, all circumstances will be considered

List Your Addresses of Residency for the Past 3 Years
Current Address
Street
City
State
Zip
How Long?
Previous Addresses
Street

City

State

Zip

How Long?
Next Previous Address
Street
City
State
Zip
How Long?
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


Current or Last Employer Information
Employer name
Phone Number
Contact Person
Position Held
Street Address
City
State
Zip
Dates Employed:
From: Mo/Yr
To: Mo/Yr
Salary/Wage
Was a CDL
Licence Required?
Reason For
Leaving?


Past Empoyer (1) Information
Employer Name
Phone Number
Contact Person
Position Held
Street Address
City
State
Zip
Dates Employed:
From: Mo/Yr
To: Mo/Yr
Salary/Wage
Was a CDL
License required?
Reason for
Leaving?


Past Employer (2) Information
Employer Name
Phone Number
Contact Person
Position Held
Street Address
City
State
Zip
Dates Employed:
From: Mo/Yr
To: Mo/Yr
Salary/Wage
Was a CDL
License Required?
Reason for
Leaving?


Past Employer (3) Information
Employer Name
Phone Number
Contact Person
Position Held
Street Address
City
State
Zip
Dates Employed:
From: Mo/Yr
To: Mo/Yr
Salary/Wage
Was a CDL
License Required?
Reason for
Leaving?


ACCIDENT RECORD
For PAST 3 YEARS ( If NONE, PUT NONE

DATES
Nature of Accident
(Head-On, Rear-End,Upset, Est)
FATALITIES
Yes or No
INJURIES
Yes or No
Last Accident
Next Previous Accident
Next Previous Accident


TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 3 YEAR ( other than parking violations)
(If NONE, Please put NONE)

LOCATION
DATE
CHARGE
PENALTY


DRIVER EXPERIENCE & QUALIFICATIONS

DRIVER LICENSES
State
License No.
Type
Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
If YES
Give Details
Has any License, Permit or Privlege ever been suspended or revoked?
If YES
Give Details


FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In assordance 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 I, 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 Saftety Requlations.This certifies that this application was completed by the applicant, and that all entries and information are true and complete to the best of my knowledge.
I authorize Fox Transportation Inc 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.


Check here if you agree to the above statement