Application for Employment Powell's Sanitation
Powell's Sanitation Inc.
1776 Mt. Zion Road
Loris, SC 29569
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  • Input numbers only, no dashes
  • 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:
  • State
    License Number
    Type
    Expiration Date
  • DRIVING EXPERIENCE

    (Enter 0 if a field does not apply.)
  • Type of Equipment (Van, Tank, Flat, etc.) Date - From Date - To Approx # of Miles (total)
    Straight Truck
    Tractor and Semi-Trailer
    Tractor - Two Trailers
    Other
  • Accident Record for the Past 3 Years or More

  • Date Nature of Accident (Rear-End, Head-on, Upset) Number Fatalities Number Injuries Chemical Spills? Yes or No
    Accident 1
    Accident 2
    Accident 3
  • Traffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)

  • Date Convicted (Month/Year) Violation State of Violation Location Penalty (Forfeited Bond, Collateral, and/or Points)
    #1
    #2
    #3
  • EMPLOYMENT RECORD

    Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).
    NOTE: Must list the complete mailing address, street, city, state and zip code
  • Employer Name
    Address
    Phone
    Position Held
    Dates (From - To)
    Salary
    Reason for Leaving
    Any Gaps in Employment or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason
  • Employer Name
    Address
    Phone
    Position Held
    Dates (From - To)
    Salary
    Reason for Leaving
    Any Gaps in Employment or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason
  • Employer Name
    Address
    Phone
    Position Held
    Dates (From - To)
    Salary
    Reason for Leaving
    Any Gaps in Employment or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason
  • TO BE READ AND SIGNED BY APPLICANT

    I authorize you to make sure investigations and inquiries into 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 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 current/previous employers;
    *Have errors in the information corrected by previous 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.
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  • This certifies that I completed this application, and all entries on it and information in it are true and complete to the best of my knowledge.
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  • NOTE: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.