fillable-driver application.pdf

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Driver – Minimum Qualification Sheet Thank you for your interest in Global Logistics Trucking. Below is a quick survey to see if you meet Our minimum qualifications. Please answer all of the questions to see if you qualify. Once again. Thank you for your interest.

Applicants Name:

Please mark the answer that applies for each question: 1. Are you 18 years of age or older?

No - You do not qualify to drive for Global Logistics Trucking, Inc. Yes - please continue to # 2

2, Is your MVR accident/DWI free for the last 3 years?

No- You do not qualify to drive for Global Logistics Trucking, Inc. Yes - Please Continue to # 3

3. Do you understand that you are applying for an "At-Will" ?


4. Do you understand that you are applying for an "Independent contractor position-1099" position and that the company is not offering employment for any length of time?


5. Do you understand that Global Logistics Trucking, Inc. is an Equal Employment Opportunity Employer?


6. Do you have 5 OR LESS tickets on your MVR?

No -You do not qualify to drive for Global Logistics Trucking, Inc. Yes - Please continue to # 7

7. Do you have at least 3 years of verifiable driving Experience?


8. Have you hauled pipe before?


How much experience do you have hauling pipe. 0-3 Months 3 Months – 6 Months 6 Months – 1 Year 1 Year or more 9. Have you hauled steel coils before?


How much experience do you have hauling steel coils? 0-3 Months 3 Months – 6 Months 6 Months – 1 Year 1 Year or more 10. Do you have tarping experience?


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11. What Region are you interested in?

Local Regional OTR

If you have answered all the questions and instructed to read below; then you are qualified to apply with Global Logistics-Trucking. Please continue on with the application. Please remember to return both your questionnaire and application form.

DRIVER'S APPLICATION FOR EMPLOYMENT

Global Logistics - Trucking is an Equal Opportunity Employer and is committed to complying with State and

Federal equal opportunity law. Qualified applicants are considered for all positions without regard to race, color, religion,

sex, national origin, age or disability.

Date of Application_Click here to enter a date.

Name.____________________________________________ Social Security No.___________________

Last First Middle

Driver’s License Number:___________________________________________

Date of Birth ______________________________ Can you provide proof of age?_____________________________________ (MUST BE AT LEAST 18 years OF AGE)

Home Phone: __________________________Cell Phone: _____________________________________

Emergency Number: ____________________Emergency Contact Person: ________________________

Email Address:______________________________________________

Position (s) Applied for: Flatbed

Van

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Heavy Haul

All of the Above

How did you hear about us?

Facebook

Craigslist

Referral

Texas Workforce Commission

Driver ______________________

Other

List your addresses of residency for the past 5 years.

Current Address:

Click here to enter text.Click here to enter text. Click here to enter text. How Long?_______

Current Address: Street City/State Zip

Previous Address:

Click here to enter text.Click here to enter text. Click here to enter text. How Long?_______

Current Address: Street City/State Zip

Do you have the legal right to work In the United States? ________________________________________________

Do you have the transportation to from work?( a vehicle to leave at the yard) _________________________________

Yes

NO

Are you now employed? If not, how long has it been since you left your last employment?

Yes

NO

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in

the attached job description)?__________________________________________________________________________

If yes, explain, __________________________________________________________________________________

EDUCATION

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CIRCLE HIGHEST GRADE COMPLETED: 1 2 3 4 5 6 7 8

0-3 Months 3 Months – 6 Months 6 Months – 1 Year 1 Year or more

HIGH SCHOOL: 1 2 3 4 COLLEGE: 1 2 3 4

0-3 Months 3 Months – 6 Months 6 Months – 1 Year 1 Year or more

LAST SCHOOL ATTENDED Click here to enter text.Click here to enter text. (NAME) (CITY)

ARE YOU FAMILIAR WITH HOW TO COMPLETE AN ACCIDENT REPORT FORM AND THE PROCEDURES TO TAKE IF AN ACCIDENT

OCCURS?

ACCIDENT RECORD FOR THE PAST 5 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS

NEEDED) DATES NATURE OF ACCIDENT FATALITIES INJURIES

TRAFFIC CONVICTIONS/ TICKETS AND FOREFEITURES FOR THE PAST 5 YEARS (OR OTHER

PARKING VIOLATIONS) (IF NONE, WRITE NONE)

LOCATION DATE CHARGE PENALTY

OPEN TICKETS/WARRANTS:

YES

NO

LICENSENSE RESTRICTIONS:

YES

NO

Have you ever been convicted of a CRIME in the last 10 years…(MISDEMEANOR OR FELONY). YES or NO

….Explain on separate paper.


CRIMINAL CONVICTIONS/ TICKETS AND FOREFEITURES FOR THE PAST 5 YEARS (Have you ever been

convicted of any criminal activity involving CMV or while in CMV. YES or NO ….Explain on separate paper.


OPEN

TICKETS/WARRANTS:

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A. Do you have a current Drivers Licenses issued by more than one state?

a. YES_____ NO ________

(Please include DL #Click here to enter text. (Any restrictions?)____________________________________)

b. YES____ _NO ________

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

YES____ _NO _______

If yes, please explain the circumstance’s on a separate piece of paper.

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

C. Has any license, permit or privilege ever been suspended or revoked

a. YES____ NO ________

If the answer to either B or C is yes, attach statement giving details.

DRIVING EXPERIENCE IF NONE, WRITE “NONE” CLASS IF TYPE DATE DATE APPROX NO OF MILES

STRAIGHT TRUCK

TRACTOR(FLATBED)

TRACTOR-VAN OR REEFER

TRACTOR-DROP DECK

List the states operated for the last five years.

Which safe Driving Awards do you hold?______________________________________________

Houston, Texas Voice: 281-631-0763/832-692-1643 Fax: 281-440-9738 [email protected]

[email protected]

Name:Choose an item. SS# _____________ DOB __/__/__ Have you had a positive drug test in the last 2 yrs.?

YES____ _NO _______

when?_________________________

Please Explain: ________________________________________________________________

Have you ever filed unemployment? YES____ _NO _______

when?_________________________

Please Explain:__________________________________________________________________

Have you ever been injured on the job? YES____ _NO _______

when?_________________________

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Please Explain: __________________________________________________________________

Have you ever filed Worker’s Compensation?(please complete attached form) YES____ _NO _______

when?_________________________

Please Explain:__________________________________________________________________

All driver applicants to drive in interstate commerce must provide the following information on all employers

During the past 5 years…If you were unemployed for a period of one month or longer, please state your activities

during that time

At least 3 years driving experience with at least 3 year flat bed, please include phone number to contact previous

employer to verify employment Start and end date of your most recent employer.

PLEASE LIST ALL “FLATBED RELATED” EMPLOYERS BELOW (last 7 years)

CURRENT OR LAST EMPLOYER Phone REASON FOR LEAVING START DATE /END DATE

ADDRESS Fax EQUIP NOTES

Subject to FMCSR yes or no











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YOUR UNDERSTANDING AND AGREEMENT TO THE TERMS OF THIS APPLICATION 1 I, (referred to also as the contractor) understand that I may be denied or removed after accepting the above contract position if the information I

provide in this application is not completely truthful. The information I provide in this application is completely truthful to the best of my knowledge

and belief.

2 I authorize Global Logistics - Trucking to verify all of the information I provide in this application and Understand that Global Logistics -

Trucking, Inc. may contact anyone with knowledge about me. I agree not to sue or hold liable any persons who respond to Global Logistics - Trucking questions about me.

3 I understand that I am applying for a position that is At-Will and that if I am hired: Global Logistics - Trucking makes no guarantees about the

length of my contract if hired.. I understand that Global Logistics - Trucking can terminate my contract at any time and that in return, and I agree to

provide Global Logistics - Trucking a one week notice.

Please circle those that apply:

Please include a copy of all items listed below:

SSN card:

DOT card:

Driver's License:

DAC- Phone: 1800-381-0645 Fax: 1-918-664-5520

http://www.hireright.com/Consumers-Applicants.aspx--- please use [email protected] as the email address.

MVR: http://www.texasonline.gov

Other:

TWIC:

HAZMAT:

TANKERS:

DOUBLE/TRIPLES:

APPLICANT'S SIGNATURE INDICATES ACCEPTANCE OF THE TERMS ABOVE

__Choose an item.___________________________________ ______________ Printed Name Signature

Click here to enter a date. Date

DRIVER BACKGROUND INVESTIGATION RELEASE

In connection with your application for employment with Global Logistics Trucking, it may

obtain one or more reports regarding your credit, driving, and/or criminal background history

from a consumer reporting agency and/or other sources.

I authorize Global Logistics Trucking, to contact any organization or individual that I have

listed on my employment application or resume or mention in job interviews and obtain from

them any relevant information about my job qualification, including my experience skills, and

abilities. I understand that I am consenting to the release of safety performance information

including crash data from the previous five years and inspection history from the previous five

http://www.hireright.com/Consumers-Applicants.aspx---

mailto:[email protected]

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years, as well as any reference-related information about me held or known by my former

employers, supervisors, and co-workers. In addition I consent to release of any information

about my education, experience, abilities, or work-related characteristics or traits held or known

by other organizations or individuals, including school and educational institutions, professional

or business associates, and friends and acquaintances that might be contacted in the course of

conducting a reference check or background investigation of my suitability for employment.

I understand and acknowledge that is release of information can involve my qualifications,

performance, credentials or other characteristics or factors affecting my suitability for

employment with employer. Specifically, I am authorizing the release of any information

about my performance, experience capability, attitude, specific events, or other work-related

characteristics that currently are in the possession of the requested organization or their

managers or representatives.

I agree not to file or pursue any complaints, claims, or legal actions of any kind against any

organization or individual that provides work related information about me to Global Logistics

Trucking or its agents in accordance with the terms and intent of this release. I also agree not to

file or pursue any complaints, claims, or legal actions against Global Logistics Trucking or any

of its employees, representatives, or agents arising out of their efforts to obtain work related

information about me.

I understand that signing this consent form gives Global Logistics Trucking, Inc. and/or any

other entity it retains; permission to obtain background reports and may obtain reports of my

credit, driving, and criminal background history in addition to information regarding my

background, references, education, specific events, and past employment.

I hereby authorize Global Logistics Trucking and its employees, agents, and its affiliates to

obtain the information authorized above.

Print Name: Signature: Date:

Choose an item.

CERTIFICATION COMPLIANCE WITH DRIVER LICENSE REQUIREMENT

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, transports hazardous materials that require placarding. The requirements in part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 26 ,001 pounds or more, can transport more than 15 people, transports hazardous materials that require placarding. DRIVER REQUIREMENTS: Parts 3836 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements re in effect as of July 1, 1987. They are as follows:

1. You as a commercial driver, may not possess more than one license.

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2. If you currently have more than one license you should keep the license from your state of residence, and return

the additional license to the state that issued them. Destroying a license does not close the record in the state that issued it, you must notify the state.

3. Sections 392.42. and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In addition, Section 383.3 requires that any time you violate a state or local traffic law(other than parking), you must report it to your employing motor carrier and the state that issued your license within 30 days.

DRIVER CERTICATION: I certify that I have read and understand the above requirements. The following license is the only one I possess:

Print Name:Click here to enter text. Date: Signature:

Driver License Number: Choose an item. State: Choose an item.Expiration:Click here to enter a date.

LICENSE RESTRICTIONS: Choose an item.

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

Have you ever tested positive, adulterated, or substituted test specimen? YES or NO

Have you ever refused drug/alcohol test of any kind?(pre-employment, post-accident, random)? YES or NO

Have you had an alcohol test with a result of .04 or higher? YES or NO

If you answered yes to any of the following please attach a statement of explanation.

I understand, that as required by the Federal Motor Carrier Safety Regulations or company policy, all drivers must submit to alcohol and controlled substance testing as a condition of employment. I also understand that any offer of employment will be contingent upon the results of an alcohol and controlled substance test.

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Therefore, I agree to submit to the following alcohol and controlled substance tests in accordance and as defined by the Federal Motor Carrier Safety Regulation and this company’s policies:

Pre-Employment, to determine employment eligibility

Random

Reasonable suspicion

Post-Accident

Follow up

Return to duty I certify that I have read and understand, and agree to abide by the condition of this consent and release form. Failure to sign will prevent this employer from using you as a CMV driver.

Signature/Date:

Print Name: Click here to enter text.

SSN: Choose an item.

fillable-driver application.pdf

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