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Fairmont Facility: (507) 238-4391 | New Richland Facility: (507) 465-3789
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DRIVER APPLICATION

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DRIVER APPLICATIONPooleys2023-09-28T16:49:56-05:00

Applicant Information

Position Applying For(Required)
Name(Required)
Current & Previous Three Years Addresses(Required)
Address
From
To
 
Have you worked for this company before?(Required)
If yes, give dates

Education History

Please select the highest grade completed.
Grade School
College
Post Graduate

Employment History

Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self employment periods, and all commercial driving experience for the past ten (10) years.
Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 2nd employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 3rd employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 4th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 5th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 6th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 7th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 8th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 9th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 10th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 11th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 12th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 13th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?
Would you like to add a 14th employment history or commercial driving experience record?(Required)

Employer Info(Required)
Present or Last Employer Name
Position Held
Address
Reason for leaving
Company phone
FMCSRs(Required)
Were you subject to the FMCSRs while employed here?
49 CFR Part 40(Required)
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?

Driving Experience

Class of Equipment(Required)
Please select the class of equipment you'd like to include experience for.
Straight Truck(Required)
From
To
Approximate Number of Miles
 
Tractor & Semi Trailer(Required)
From
To
Approximate Number of Miles
 
Tractor & Two Trailers(Required)
From
To
Approximate Number of Miles
 
Tractor & Triple Trailers(Required)
From
To
Approximate Number of Miles
 
Other(Required)
From
To
Approximate Number of Miles
 
Accident Record for past three (3) years(Required)
Date of Accident
Nature of Accident (Head on, rear end, etc)
Location of Accident
# of Fatalities
# of People Injured
 
Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations)(Required)
Date
Location
Charge
Penalty
 
Driver's License (list each driver's license held in the past three (3) years(Required)
State
License
Type
Endorsements
Expiration Date
 
Have you ever been denied a license, permit or privilege to operate a motor vehicle?(Required)
Has any license, permit or privilege ever been suspended or revoked?(Required)
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?(Required)
Have you ever been convicted of a felony?(Required)

Job References

List three (3) persons for references, other than family members, who have knowledge of your safety habits.
Reference(Required)
Name
Address
Phone
Reference(Required)
Name
Address
Phone
Reference(Required)
Name
Address
Phone

To Be Read and Signed by Applicant

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to obtain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete examinations as may be required to complete my application file.

It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant.

It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

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.

Applicant Signature(Required)
  • Your Name
  • Your Name
  • Your Name

NEW RICHLAND FACILITY

13984 215th Avenue, New Richland, MN

Phone: (507) 465-3789

Fax: (507) 465-3258

FAIRMONT FACILITY

620 N. Main Street Fairmont, MN

Phone: (507) 238-4391

Fax: (507) 238-1355

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