Employment

DRIVER APPLICATION

*Name

*Phone Number

*eMail

*Date of Application

*Social Security #

*Current Address (Street Number / City / State / Zip)

Previous Address

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

Yes No

*Date of Birth

*Are you employed now?

Yes No

If not, how long since leaving your last employment?

*How did you hear about Cody Keys Trucking, LLC?

Rate of pay expected?

Home time desired?

Please provide any tickets: Location / Date / Charge / Penalty

Please provide any accidents: Date / Nature Of Accident / Fatalities / Injuries / Hazardous Spill

Please provide any criminal convictions including the dates

*How long have you had a valid CDL-A?

Please list all of your endorsements

*Employment History #1 - Please Include Employer Name, Address, Employed From - To, Contact Person, Phone Number, Salary, Reason For Leaving

*Were you subject to 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 49 CFR Part 40?

Yes No

Employment History #2 - Please Include Employer Name, Address, Employed From - To, Contact Person, Phone Number, Salary, Reason For Leaving

Employment History #3 - Please Include Employer Name, Address, Employed From - To, Contact Person, Phone Number, Salary, Reason For Leaving

*Driver Licenses Held In The Past 3 Years #1 - State / License Number / Class / Endorsements / Expiration Date

Driver Licenses Held In The Past 3 Years #2 - State / License Number / Class / Endorsements / Expiration Date

Driver Licenses Held In The Past 3 Years #3 - State / License Number / Class / Endorsements / Expiration Date

Driver Licenses Held In The Past 3 Years #4 - State / License Number / Class / Endorsements / Expiration Date

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

Yes No

*Has a license, permit or privilege ever been suspended or revoked?

Yes No

If either of the two questions above answer is YES, please give details here:

*Driving Experience - Please List: Class of Equipment (straight truck, doubles, tanker, etc), Dates, Approximate Number of Miles and Endorsements Required

List states operated in for the last five years:

List any special courses or training that will help you as a driver:

List any safe driving awards you hold and from whom?

List any trucking, transportation or other experience that may help in your work for this company Include any courses and training, special equipment or technical materials you can work with, etc

*Education - Include Highest Grade Completed, name and address of School

*E-Sign - By Entering my Name below, I certify 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

Fields with (*) are compulsory.

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