Driver's Application For Employment - Alliant Metals Inc.

800-543-1453 sales@alliantmetals.com

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Driver Application For Employment

Step 1 of 8

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In compliance with the Federal and 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.
Name*
First Middle Last
Position Applied For*
Email*
Phone*
Driver License #*
Expiration*
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How Long Have You Lived Here?*
Previous Addresses
Address
Street Address City State / Province / Region ZIP / Postal Code
How Long Did You Live Here?

How Long Did You Live Here?
Would you like to add another previous address?
- Yes
- No
Address
Street Address City State / Province / Region ZIP / Postal Code
How Long Did You Live Here?

How Long Did You Live Here?
Would you like to add another previous address?
- Yes
- No
Address
Street Address City State / Province / Region ZIP / Postal Code
How Long Did You Live Here?

How Long Did You Live Here?

Application Continued
Do you have legal right to work in the United States?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY
Can you provide proof of age?*
- Yes
- No
Have you worked for this company before?*
- Yes
- No
If yes, where?
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Rate of Pay
Position
Reason for leaving?
Are you now employed?*
- Yes
- No
If not, how long since your last employment?
Who referred you?
Rate of pay expected?*
Have you ever been bonded? (Answer only if a job requirement)*
- Yes
- No
Name of bonding company?
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please explain fully.
Conviction a crime is not an automatic bar from employment. All circumstances will be considered.
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described by the attached job description)?*
- Yes
- No
If yes, please 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 additional 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
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position Held
Salary/Wage
Reason for leaving?
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 49 CFR part 40?
- Yes
- No
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position
Salary
Reason for leaving?
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 49 CFR part 40?
- Yes
- No
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position
Salary
Reason for leaving?
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 49 CFR part 40?
- Yes
- No
Would you like to add more employment history?
- Yes
- No
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position
Salary
Reason for leaving?
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 49 CFR part 40?
- Yes
- No
Would you like to add more employment history?
- Yes
- No
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position
Salary
Reason for leaving?
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 49 CFR part 40?
- Yes
- No
Would you like to add more employment history?
- Yes
- No
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Contact Person Phone Number
Start Date of Employment:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Position
Salary
Reason for leaving?
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 49 CFR part 40?
- Yes
- No

Accident Record
For past 3 years or more. If none, do not fill in.
Date of Accident
MM slash DD slash YYYY
Nature of Accident
Head-on, rear end, upset, etc.
Fatalties
Injuries
Hazardous Material Spill
Date of Accident
MM slash DD slash YYYY
Nature of Accident
Head-on, rear end, upset, etc.
Fatalties
Injuries
Hazardous Material Spill
Date of Accident
MM slash DD slash YYYY
Nature of Accident
Head-on, rear end, upset, etc.
Fatalties
Injuries
Hazardous Material Spill
Traffic Convictions
and Forfeitures other than parking violations.
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty

Experience and Qualifications
List all driver licenses or permits held in the past 3 years
Driver License

License Number
License State

License State
License Type

License Type
License Expiration Date

License Expiration Date
Driver License

License Number
License State

License State
License Type

License Type
License Expiration Date

License Expiration Date
Driver License

License Number
License State

License State
License Type

License Type
License Expiration Date

License Expiration Date
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle*
- Yes
- No
B. Has any license, permit or privilege been suspended or revoked.*
- Yes
- No
If the answer to A or B is yes, give details.

Driving Experience
Straight Truck*
- Yes
- No
Type of Equipment
- Van
- Tank
- Flat
- Dump
- Refer
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Tractor and Semi-Trailer*
- Yes
- No
Type of Equipment
- Van
- Tank
- Flat
- Dump
- Refer
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Tractor - Two Trailers*
- Yes
- No
Type of Equipment
- Van
- Tank
- Flat
- Dump
- Refer
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Tractor - Three Trailers*
- Yes
- No
Type of Equipment
- Van
- Tank
- Flat
- Dump
- Refer
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Motorcoach - School Bus*
More than 8 Passengers
- Yes
- No
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Motorcoach - School Bus*
More than 15 Passengers
- Yes
- No
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Number of Miles
Other Driving Experience
List states operated in for the last 5 years.
List 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 this company
List courses or training other than shown elsewhere in this application.
List special equipment or technical materials you can work with (other than already shown).

Education
Highest Grade Completed
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
High School
- 1
- 2
- 3
- 4
College
- 1
- 2
- 3
- 4
Last School Attended
City and State of School
Date Attended

Please Read and Check the Below Box*
- This certifies that this application was completed by me, and that all entries in it and information in it are true and completed to the best of my knowledge.
By checking the below box:*
I authorize you to make such investigations and inquiries of 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 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 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 to the accuracy of the information.
- By checking this box you agree to the above.
Date
MM slash DD slash YYYY
Signature
Phone
This field is for validation purposes and should be left unchanged.

Quick Contact

Name*
First Last
Company
Phone
Email*
Message*

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Alliant Metals Inc.

134 B Route 111 Hampstead NH 03841,New-England,United States

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