DRIVER'S APPLICATION FOR EMPLOYMENT RAD TRANSPORT, INC. 53049 PAUL DRIVE. ELKHART, IN 46514 (574) 266-1330 In compliance 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, or non-job related disability. Date of application___________ Position (s) Applied for_______________________________________________________________________________________ Name_____________________________________________________ Social Security No_____________________________ List your addresses of residency for the past three years. Current address: Street________________________________________________City____________________________________ State___________________________________Zip Code_______Phone____________How long______________ Previous Address: Street_______________________________________________City____________________________________ State___________________________________Zip Code_______How long______________ Street________________________________________________City____________________________________ State___________________________________Zip Code_______How long______________ Do you have the legal right to work in the United States?_____________________________________________________________ Date of Birth__-__-____Can you provide proof of age?_____________________ (Required For Commercial Drivers) Have you worked for this company before?__________________Where?________________________________________________ Dates: From_____________ To_______________Rate of pay__________________Position________________________________ Reason for leaving____________________________________________________________________________________________ Are you now employed?_____If not, how long since leaving last employment?____________________________________________ Who referred you?______________________________Rate of pay expected_____________________________________________ Is there any reason you might be unable to perform the functions of the job for which you have applied  (as described in the attached job description)? ______________________________________________________________________________ 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 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.  Add another sheet if necessary.) EMPLOYER DATE Name______________________________________________From__-__-____ To __-__-____ Address____________________________________________Position Held_______________ City_________________________State_____Zip_______Salary/Wage___________________ Contact Person___________________________Phone#____________ Reason for Leaving____________________________ EMPLOYER DATE Name______________________________________________From__-__-____ To __-__-____ Address____________________________________________Position Held_______________ City_________________________State_____Zip_______Salary/Wage___________________ Contact Person___________________________Phone#____________ Reason for Leaving____________________________ EMPLOYER DATE Name______________________________________________From__-__-____ To __-__-____ Address____________________________________________Position Held_______________ City_________________________State_____Zip_______Salary/Wage___________________ Contact Person___________________________Phone#____________ Reason for Leaving____________________________ EMPLOYER DATE Name______________________________________________From__-__-____ To __-__-____ Address____________________________________________Position Held_______________ City_________________________State_____Zip_______Salary/Wage___________________ Contact Person___________________________Phone#____________ Reason for Leaving____________________________ EMPLOYER DATE Name______________________________________________From__-__-____ To __-__-____ Address____________________________________________Position Held_______________ City_________________________State_____Zip_______Salary/Wage___________________ Contact Person___________________________Phone#____________ Reason for Leaving____________________________   *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers,  or any size vehicle used to transport hazardous materials in a quantity requiring placarding. ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE (ATTACHED SHEETS IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE. Dates Nature of accident Fatalities Injuries ( Head-on, Rear-end, Upset, ect.) Last accident:____________________________________________________________________ Next Previous:___________________________________________________________________ Next Previous:___________________________________________________________________ TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE. Location Date Charge Penalty_____________________________________________________ (Attach sheet if more space is needed) 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:___________________________________________________________ (Name) (City) Experience and Qualifications-Driver State License # Type Expiration Date DRIVER LICENSES ______________________________________________________________________ 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 ever been suspended or revoked? Yes_______No_______ IF THE ANSWER TO EITHER A OR B IS YES PLEASE GIVE DETAILS: A)__________________________________ ________________________________________________________________________________________________ B)_______________________________________________________________________________________________ Driving Experience- If none, write none. Class of equipment Type of equipment Dates Approx. # of miles (Van, Tank, Flat, ect.) From To (total) Straight Truck__________________________________________________________________________________________ Tractor and Semi-Trailer________________________________________________________________________________ Tractor Two Trailers___________________________________________________________________________________ Motorcoach School Bus___________________________________________________________________________________ Other_______________________________________________________________________________________________ List states operated in the last 5 years _________________________________________________________________ Show 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 and training other than shown elsewhere in this application. _____________________________________________________________________________ List special equipment or technical materials you can work with( other than those already shown) ___________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------------   TO BE READ AND ACKNOWLEDGED BY APPLICANT This certifies this application was completed by me, and all the entries on it and information in  it are true and complete to the best of my knowledge. I authorize you to take 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 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) mat result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company Date____________ Applicant's Signature_______________________