Driver Application

Name*
First Middle Last
Daytime Phone
Home Phone*
Mobile Phone
Email
Date of birth*
Date Format: MM slash DD slash YYYY
Are you a citizen of the U.S.?*
- Yes
- No
If no, do you have a valid work permit?*
- Yes
- No
Current Address
Current Address*
Street Address City State ZIP Code
How long?
How long have resided at your current address?
Addresses for past three years
Past Address 1
Street Address City State ZIP Code
How long at this address?
Past Address 2
Street Address City State ZIP Code
How long at this address?
Past Address 3
Street Address City State ZIP Code
How long at this address?
Emergency contact
In case of emergency contact:
First Last
Address
Street Address City State ZIP Code
Phone
Position
Position applied for
Temporary or permanent?
- Temporary
- Permanent
Have you ever worked for this company before?
- Yes
- No
If no, where?
Employed from
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Rate of pay
Position
Reason for leaving
List names of relatives in our employ, if applicable.
Are you currently employed?
- Yes
- No
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected
Education
High school
- 9
- 10
- 11
- 12
College
- 1
- 2
- 3
- 4
Last school attended
City of last school
General Info
Have you ever been convicted of any crime or felony?
Conviction of a crime will not automatically result in the declination of employment.
- Yes
- No
Have you ever worked for this company under another name?
- Yes
- No
If yes, what name?
Date of last DOT physical examination
Date Format: MM slash DD slash YYYY
Employment Record
Last Employer Name
First Last
Last Employer Address
Street Address City State ZIP Code
Last Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Would you like to list more previous employers?
- Yes
- No
Previous Employer 1 Name
First Last
Previous Employer 1 Address
Street Address City State ZIP Code
Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Previous Employer 2 Name
First Last
Previous Employer 2 Address
Street Address City State ZIP Code
Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Previous Employer 3 Name
First Last
Previous Employer 3 Address
Street Address City State ZIP Code
Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Previous Employer 4 Name
First Last
Previous Employer 4 Address
Street Address City State ZIP Code
Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Previous Employer 5 Name
First Last
Previous Employer 5 Address
Street Address City State ZIP Code
Position Held
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
Type of Equipment
Experience and Qualifications - Driver
Driver Licenses*
Use the (+) to add more licenses.
State License Number Type Expiration Date
Have you ever been denied a license, permit, or privileges to operate a motor vehicle?
- Yes
- No
Has any license, permit, or privilege ever been suspended or revoked?
- Yes
- No
If the answer to either of the above questions is yes, please give details below.
Driving Experience
List states operated in for last five years.
Show special courses or training that will help you as a driver.
Which safe driving awards do you hold and from whom?
Have you been in an accident in the past 3 or more years?
- Yes
- No
Please list all accidents
Use the (+) to add more.
Date Nature (head on, rear end, etc.) Fatalities Injuries
Have you had any traffic convictions and forfeitures for the past 3 years (other than parking violations)?
- Yes
- No
Please list all convictions or forfeitures
Use the (+) to add more.
Location Date Charge Penalty
Where did you hear about us?*
If you selected "Other", please specify how you heard about us in the box below.
Electronic Consent*
By typing your name in the box below you verify that all information provided is true and accurate to the best of your knowledge.
By submitting this application you understand and agree to our Privacy Policy, Terms Of Use, and that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations.

Holmes Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Comments
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