Employment Information & Application Form

Are you looking for a driving job where they call you by your first name and understand that family is important?

Our below application will have you considered for that kind of job.

We provide Blue Cross Blue Shield health insurance, Home time, Vacation pay, Weekly pay and Paid training.
We require two years driving experience, and tanker endorsement. (No Haz-Mat required at this time)

SUBMITTING YOUR APPLICATION INDICATES YOU WOULD LIKE TO BE CONSIDERED FOR EMPLOYMENT with Joe T Smith, Inc.

We will contact you.  Thank you for your time and interest in our company!

  • This application take can take 10 – 15 minutes to complete.
  • For best results please complete as many sections as possible.
  • You cannot save an application in progress and all information must me submitted in one application.
  • We recommend it be done on a computer and not a mobile device.
  • You may find it easier to use the TAB KEY between input fields.
  • After you click submit it can take a minute.

*indicates required fields

contact form 7 "form"

indicates required fields *

First Name: *
Last Name: *
email address: *
Date of Birth: *
(Format mm/dd/yyyy)
Can you provide proof of age? *
Location Preference: *
Position Applied For: *
Social Security Number: *

Current Address

Street Address: *
Apt. Number:
Current City: *
State: *
Zip Code: *
How many years/months: *
Phone Number: *

Previous Addresses (cover minimum 10 years)

Previous Address 1

Street Address:
Apt. Number:
City:
State:
Zip Code:
How Long? Years/Months:

Previous Address 2

Street Address:
Apt. Number:
City:
State:
Zip Code:
How Long? Years/Months:

Additional Address Info

(Please fill if the previous addresses do not cover a 10 year period)

Employment

Do you have the legal right to work in the United States? *
Have you worked for this company before? *
If so, where?
Previous Employee: Dates Worked From:
(Format: mm/yyyy)
Previous Employee: Dates Worked to:
(Format mm/yyyy)
Salary/Wage $
Salary Period
Position
Reason for Leaving
Are you now employed? *
Who referred you? *
Have you ever been convicted of a felony? *
If yes, please explain. Conviction of a crime is not an automatic bar from employment - all circumstances will be considered.
Is there any reason you may be unable to perform the functions of the job for which you are applying? *
If yes, explain if you wish.

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three 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 additional 7 years' information on those employers for whom the applicant operated such a vehicle.

(Note: List employers from most recent to oldest. Use only the sections required then skip to next section)

CURRENT EMPLOYMENT/EMPLOYMENT HISTORY 1

Employer Name: *
Address: *
City: *
State: *
Zip Code: *
Employment from: Dates Worked From: *
(Format: mm/dd/yy)
Employment to: Dates Worked to: *
(Format: mm/dd/yy - if still employed leave blank)
Position Held *
Salary/Wage $*
Salary Period*
Reason for Leaving *
Were you subject to FMCSRs while employed?*
Was your job designated as a safety sensitive function in any DOT regulated mode subject to drug and alchohol testing requiremnts of 49 CFR Part 40? *
May we contact this employer?*
Contact Name:
Phone Number (555-555-5555)

EMPLOYMENT HISTORY 2

Employer Name
Address
City
State
Zip Code
Employment from: Dates Worked From:
(Format mm/dd/yy)
Employment to: Dates Worked to :
(Format mm/dd/yy)
Position Held
Salary/Wage $
Salary Period
Reason for Leaving
Were you subject to FMCSRs while employed?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to drug and alchohol testing requiremnts of 49 CFR Part 40?
May we contact this employer?
Contact Name:
Phone Number (555-555-5555)

EMPLOYMENT HISTORY 3

Employer Name
Address
City
State
Zip Code
Employment from: Dates Worked From:
(Format mm/dd/yy)
Employment to: Dates Worked to :
(Format mm/dd/yy)
Position Held
Salary/Wage $
Salary Period
Reason for Leaving
Were you subject to FMCSRs while employed?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to drug and alchohol testing requiremnts of 49 CFR Part 40?
May we contact this employer?
Contact Name:
Phone Number (555-555-5555)

EMPLOYMENT HISTORY 4

Employer Name
Address
City
State
Zip Code
Employment from: Dates Worked From:
(Format mm/dd/yy)
Employment to: Dates Worked to :
(Format mm/dd/yy)
Position Held
Salary/Wage $
Salary Period
Were you subject to FMCSRs while employed?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to drug and alchohol testing requiremnts of 49 CFR Part 40?
May we contact this employer?
Contact Name:
Phone Number (555-555-5555)

Additional Employment History (Please fill if the previous jobs do not cover a 10 year period)

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE

Have you ever been involved in an accident? *
If yes, please complete the following. If no, please skip to Traffic Violations below.

ACCIDENT 1

Date of Accident 1
(Format mm/dd/yyyy)
Nature of Accident 1
Fatalities from Accident 1
Injuries from Accident 1
Haz Mat Spill from Accident 1?

ACCIDENT 2

Date of Accident 2
(Format mm/dd/yyyy)
Nature of Accident 2
Fatalities from Accident 2
Injuries from Accident 2
Haz Mat Spill from Accident 2?

ACCIDENT 3

Date of Accident 3
(Format mm/dd/yyyy)
Nature of Accident 3
Fatalities from Accident 3
Injuries from Accident 3
Haz Mat Spill from Accident 3?

TRAFFIC VIOLATIONS IN PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

Have you had any traffic violations in the past three years?*
If yes, please complete the following. If no, please skip to Experience & Qualifications

VIOLATION 1

Violation 1 City/State
Date of Violation 1
(Format mm/dd/yyyy)
Violation 1 Charge
Violation 1 Penalty

VIOLATION 2

Violation 2 City/State
Date of Violation 2
(Format mm/dd/yyyy)
Violation 2 Charge
Violation 2 Penalty

VIOLATION 3

Violation 3 City/State
Date of Violation 3
(Format mm/dd/yyyy)
Violation 3 Charge
Violation 3 Penalty

EXPERIENCE AND QUALIFICATIONS

Have you ever been denied a license, permit,
or privilege to operate a motor vehicle? *
Has any license, permit,
or privilege ever been suspended or revoked? *
If you answered yes to either of the above two questions, please explain.

LICENSE INFORMATION

LICENSE 1

License 1 State *
License 1 Number *
License 1 Class *
License 1 Endorsements * (hold ctrl key to select multiple endorsements)
License 1 Expiration Date *
(Format mm/dd/yyyy)

LICENSE 2

License 2 State
License 2 Number
License 2 Class
License 2 Endorsements (hold ctrl key to select multiple endorsements)
License 2 Expiration Date
(Format mm/dd/yyyy)

LICENSE 3

License 3 State
License 3 Number
License 3 Class
License 3 Endorsements (hold ctrl key to select multiple endorsements)
License 3 Expiration Date
(Format mm/dd/yyyy)

DRIVER EXPERIENCE

Class of Equipment (hold ctrl key to select multiple classes)
Type of Equipment (hold ctrl key to select multiple types)
Total Miles
List states operated in for last 5 years * (hold ctrl key to select multiple states)
List special courses that will help you as a driver
List other experience that may help you in your work for this company

EDUCATION

Highest grade completed. *
Last School Attended*
Last School Attended City*
Last School Attended State*

Please put a check in each of the below boxes indicating your agreement.*

I authorize Joe T. Smith, Inc and its representatives to make investigations and inquiries of my personal, employment, and financial or medical history and other related matters as may be necessary in arriving at an employment decision.
I hereby release employers, schools, healthcare 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 and that I am required to abide by all rules, policies, and regulations of Joe T. Smith, Inc.
I understand that the information I have provided in this application regarding current or previous employers may be used, and those employers will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23d&e
I understand that I have the right to review information provided by 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.
I understand that I must 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.
I certify that I have read and agree with the above-stated terms and further certify that this application was completed by me, and that all information and entries are true and correct to the best of my knowledge.
Electronically Signed - Print your name below to Accept*

Please remember this form takes a while to submit

(If submitted successfully you will see your printed name above go blank)