Houff Corporation - Driver Application

Personal Information

Position(s) Applied For *

Last Name *

First Name *

Middle Name

Email Address *

Current Address

Street *

City *

State *

Zip Code *

Phone *

How Long at this Address? *

Previous Addresses (past 3 years)

Previous Address 1

Previous Address 2

Previous Address 3

General Questions

Do you have the legal right to work in the United States? *

Yes No

Date of Birth *

Can you provide proof of age? *

Yes No

Have you worked for this company before? *

Yes No

Are you now employed? *

Yes No

Who referred you?

Rate of pay expected

Have you ever been bonded? *

Yes No

Have you ever been convicted of a felony? *

Yes No

Is there any reason you might be unable to perform the functions of the job? *

Yes No

Employment History

All driver applicants to drive in interstate commerce must provide information on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle shall also provide an additional 7 years' information on employers for whom the applicant operated such vehicle. List employers in reverse order starting with the most recent.

Employer 1 (Most Recent)

Employer Name *

Address *

City *

State *

Zip *

Contact Person *

Phone Number *

From (Mo) *

From (Yr) *

To (Mo) *

To (Yr) *

Position Held *

Reason for Leaving *

Subject to FMCSRs^* while employed? *

Yes No

Safety-sensitive function subject to DOT drug/alcohol testing (49 CFR Part 40)? *

Yes No

You can add up to 6 employers.

*FMCSRs (Federal Motor Carrier Safety Regulations) 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 10,001 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.

Driving Record

Accident Record (Past 3 years or more - if none, leave blank)

Dates	Nature of Accident	Fatalities	Injuries	Hazmat Spill

Traffic Convictions (Past 3 years, other than parking - if none, leave blank)

Location	Date	Charge	Penalty

Experience & Qualifications

Driver Licenses (held in the past 3 years) *

State	License No.	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 ever been suspended or revoked? *

Yes No

Driving Experience

Check the types of equipment you have experience with and provide details.

Straight Truck

Tractor and Semi-Trailer

Tractor - Two Trailers

Tractor - Three Trailers

Motorcoach/School Bus (8+ passengers)

Motorcoach/School Bus (15+ passengers)

Other

List states operated in for the last five years

Special courses or training that will help you as a driver

Safe driving awards held and from whom

Additional Qualifications & Education

Other Experience

Trucking, transportation, or other experience that may help in your work for this company

Courses and training other than shown elsewhere in this application

Special equipment or technical materials you can work with

Education

Highest Grade Completed *

Last School Attended (Name) *

City, State *

Review & Submit

Authorization

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, 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.

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.

Signature *

Date

Personal Information

Current Address

Previous Addresses (past 3 years)

General Questions

Employment History

Employer 1 (Most Recent)

Driving Record

Accident Record (Past 3 years or more - if none, leave blank)

Traffic Convictions (Past 3 years, other than parking - if none, leave blank)

Experience & Qualifications

Driver Licenses (held in the past 3 years) *

Driving Experience

Additional Qualifications & Education

Other Experience

Education

Review & Submit

Authorization

Application Submitted Successfully!