EmailMe Form - Grand Traverse Container Driver's Application

In compliance with Federal an State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status

I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires 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 informatio in connection with my application.

In the event of employment, I understand that false or misleading informatio ngiven 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 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 information provided by previous employers;
*Have errors in the infmation corrected by revious employers and for those previous employers to re-send the corrected information to 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.

Signature *

First Last

Date *

MM / DD / YYYY

List your addresses of residency for the past 3 years.

Phone

First Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Second Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Third Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

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

Yes

No

Date of Birth (required for commercial Drivers) *

MM / DD / YYYY

Can you provide proof of your age?

Yes

No

Have you ever worked for GT Container?

Yes

No

If yes provide the start date.

MM / DD / YYYY

End date.

MM / DD / YYYY

Rate of Pay

$ Dollars . Cents

Position

Reason for leaving

Are you now employed?

Yes

No, how long since lst employed?

Were you referred?

No

Yes, who referred you?

Rate of pay expected?

$ Dollars . Cents

Have you ever been bonded? (Answer only if a job requirement)

Name of bonding company.

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.

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an addtiional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.

Employer 1

Company Name *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor's Name

First Last

Phone

### - ### - ####

Job Title

Starting Salary

$ Dollars . Cents

Ending Salary

$ Dollars . Cents

Start Date

MM / DD / YYYY

Are you still employed with this company

No

Yes

End Date

MM / DD / YYYY

Reason for leaving

May we contact your previous supervisor for reference?

No

Yes

Were you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of the 49 GFR part 40?

Yes

No

Employer 2

Company Name

Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor's Name

First Last

Job Title

Starting Salary

$ Dollars . Cents

Ending Salary

$ Dollars . Cents

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Reason for leaving

May we contact your previous supervisor for a reference?

No

Yes

Were you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of the 49 GFR part 40?

Yes

No

Employer 3

Company Name

Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Supervisor's Name

First Last

Job Title

Starting Salary

$ Dollars . Cents

Ending Salary

$ Dollars . Cents

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Reason for leaving

May we contact your previous supervisor for a reference?

No

Yes

Were you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of the 49 GFR part 40?

Yes

No

Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicles used to transport hazardous materials in a quantity requiring placecarding.

The Federal Motor Carrier Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or porperty when the vehicle (1) weighs or has a GVWR of 10,001 points 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 placecarding.

Accident Record

	Dates	Nature of the Accident	Fatalities	Injuries	Hazardous Material Spill
Last Accident
Next Accident
Next Accident

Traffic Convictions

And forfeitures for the past 3 years (other than parking violations) if none put none.

	Location	Date	Charge	Penalty
First Conviction
Second Conviction
Third Conviction

Experience and Qualifications - Driver

Driver licenses or permits held in the past 3 years

	State	License No.	Class	Endorsment (s)	Expiration Date
Qualifications
Qualifications
Qualifications

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

Yes

No

Has any license, permit or priviledge ever been suspended or revoked

Yes

No

If the answer to either A or B is yes give details.

Driver Experience

Straight Truck

Yes

No

Vehicle Type

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Tractor and Semi-Trailer

Yes

No

Vehicle Type

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Tractor - Two Trailers

Yes

No

Vehicle Type

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Tractor Three-Trailers

Yes

No

Vehicle Type

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Motorcoach - School Bus

Yes

No

More than 8 passenger

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Motorcoach - School Bus

Yes

No

More than 15 passengers

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

Other

Yes

No

Vehicle Type

Dates From

MM / DD / YYYY

Dates To

MM / DD / YYYY

Approximite NO of Miles (Total)

List states operated in for the last five years

Special courses or training that will help you as a driver.

Which safe driving awards do you hold, and from whom?

Experience and Qualifications - Other

Show any trucking, transportation or other experience that may help in your work for GTC.

List courses and training other than shown elsewhere in this application.

List special equipment or technical materials you can work with (other than those alreasy shown)

Education

Highest Grade Completed

Years of High School completed

1

2

3

4

Years of College completed

1

2

3

4

Number

Email

Last School Attended

Name
City
State

TO BE READ AND SIGNED BY APPLICANT

First Last

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

Date Signed

MM / DD / YYYY