CAREERS

License Information
Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Driving Experience
Fill in the columns below that apply to your driving experience. Please include type of equipment (Van, Tank, Flat, Etc.), dates and approximate mileage.

Accident Record for the Last 3 Years
Please provide your accident record for the past three years. Include dates, the nature of the accident (ex: head-on, rear-end, upset etc.), number of fatalities, number of injuries, and whether or not there was a chemical spill.

Do you have any traffic convictions and/or forfeitures (other than parking violations) over the past three years?

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? If yes, explain.

B. Has any license, permit, or privilege ever been suspended or revoked? If yes, explain.

Have you been in any accidents over the past three years?

Employee Record
Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three (3) years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven (7) years prior to the initial three (3) years (total of ten (10) years employee history).

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MM/YYYY) AND REASON.

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MM/YYYY) AND REASON.

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MM/YYYY) AND REASON.

TO BE READ AND SIGNED BY THE APPLICANT

I authorize you to make sure investigations and inquiries to 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.

“I understand that the information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review the information provided by current/previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.

Background Investigation Consent
I hereby authorize Duvall Carriers, LLC and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, and criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with Duvall Carriers, LLC.

I release Duvall Carriers, LLC and/or its agents and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name, and all information is true and correct to the best of my knowledge, for the seven (7) years prior to the initial three (3) years (total of ten (10) years employee history).

*The above information is required for identification purposes only, and is in no manner used as qualifications for employment. Duvall Carriers, LLC is an equal opportunity employer and does not discriminate on the basis of sex, race, religion, age (40 and over), handicap or national origin.