Driver Application

At Foltz Trucking, Our People Make The Difference.

Foltz Trucking is a family owned and operated business where you will be treated with respect. We operate late model Volvo equipment that will keep you trucking. Driver requirements include having at least two years of driving experience and be a minimum of 23 years old.

Foltz Trucking’s benefit package includes:

Holiday Pay

Vacation Pay

Health Insurance

401K

Health and Wellness Screening

Foltz Hiring Map

Take a few minutes to fill out the driver application form below:

Driver (Commercial) Application

If you are human, leave this field blank.

NOTICE:

Before an application is submitted, the motor carrier must inform the applicant that the information he/she provides is in accordance with paragraph (b) (10) of this section may be used, and the applicant's previous employers will be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraphs (d) and (e) of 391.23.

PLEASE PRINT and ANSWER ALL QUESTIONS

Date

PERSONAL INFO

First Name *

First

Last Name *

Last

Current Address (must have 3 years of address listed) *

Current Address (must have 3 years of address listed)

City

State/Province

Zip/Postal

Country

Previous Address

City

State/Province

Zip/Postal

Country

Previous Address

City

State/Province

Zip/Postal

Country

Phone *

Email *

In case of EMERGENCY, please notify: *

Relationship *

Home Phone *

Work Phone *

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

2. Date of birth (month/day/year): *

3. Proof of age *

Social Security number *

4. Have you worked for this company before? *

Yes

5. If yes, for which client (company)?

Dates worked from (dd/mm/yy):

Dates worked to (dd/mm/yy):

Rate of pay

Position

Reason for leaving

6. Are you now employed? *

Yes

7. Who referred you? *

8. Position applied for: *

9. Rate of pay expected? *

PHYSICAL HISTORY

Do you have any physical conditions which may limit your ability to perform the job applied for? *

Yes

If yes, what can be done to accommodate your limitations? *

Are you physically capable of heavy, manual work? *

Yes

If no, please explain:

How much time have you lost from work in the past 3 years? Also, please explain:

Would you be willing to take a physical examination? *

Yes

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the precising three (3) years. Applicants to drive a commercial motor vehicle (as defined by the USDOT) intrastate or interstate commerce show also provide an additional seven (7) years information on those employers for whom the applicant was an operator of a commercial motor vehicle. Before an application is submitted, the motor carrier must inform the applicant that the information he/she provides in accordance with paragraph (b) (10) of this section may be used, and the applicant's previous employers will be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraph (d) and (e) of 391.23.

MUST LIST 10 YEARS OF PREVIOUS EMPLOYMENT

Current Employer Name

May we contact your current employer?

Yes

Phone Number

Address

City

State/Province

Zip/Postal

Country

Dates worked - From mm/dd/yy to mm/dd/yy

Position

Wage

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Registration while employed?

Yes

Was your job designated as safety sensitive function in any DOT regulated made subject to drug and alcohol testing?

Yes

OTHER EMPLOYMENT

Past Employer/Contact Person

Phone Number

Address

City

State/Province

Zip/Postal

Country

Dates worked - From mm/dd/yy to mm/dd/yy

Position

Wage

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Registration while employed?

Yes

Was your job designated as safety sensitive function in any DOT regulated made subject to drug and alcohol testing?

Yes

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DUE PROCESS RIGHTS

Following are your rights in regard to your safety performance history information: - The right to review information provided by the previous employer - The right to have errors in the information corrected by the previous employer, and for that previous employer to resend the correct information to the prospective employer; and, - The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information

More Information

(i)(2) Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from previous employer(s), then the five-business days deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records. Please contact Human Resources for more information.

ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE

ACCIDENT ONE

Dates

Nature of Accident/Incident

Fatalities

Injuries

ACCIDENT TWO

Dates

Nature of Accident/Incident

Fatalities

Injuries

ACCIDENT THREE (add more if needed)

Dates

Nature of Accident/Incident

Fatalities

Injuries

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TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (other than parking violations)

(add more if needed)

Location

Date

Charge

Penalty

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EXPERIENCE AND QUALIFICATIONS (Driver)

DRIVER'S LICENSES

Date of each unexpired commercial motor vehicle operator's license or permit that h as been issued to the applicant;

STATE

LICENSE NO.

TYPE

EXPIRATION

Add Remove

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

Yes

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

Yes

If you have answered yes to any of these questions, please give details below:

Section

(b)(9) A statement setting forth in detail the facts and circumstances of any denial, revocation, or suspension of any license, permit, or privilege to operate a motor vehicle that has been issued to the applicant, or a statement that no such denial, revocation, or suspension has occurred;

DRIVING EXPERIENCE

(add more if needed)

Class of Equipment

Type of Equipment

(van, tank, flat, etc.)

Dates (from mm/dd/yy to mm/dd/yy)

Total # of Miles

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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 who?

Please review the form before submitting!

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