Schnell Transport Application Schnell Driving job Application (#8) In compliance with federal and State equal opportunity law, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or non-job related disabilities.APPLICANT INFORMATIONFirst NameMiddle InitialLast NameCURRENT & PREVIOUS THREE YEARS ADDRESSES:Address Line 1Address Line 2CityStateZip CodeAddress 2Address Line 1Address Line 2CityStateZip CodeAddress 3Address Line 1Address Line 2CityStateZip CodeList Any Additional Addresses HerePosition Applying ForDriverOwner OperatorOffice StaffSocial Security NumberDate of BirthEmailPhone NumberDate of Application Do You Have a Current Commercial Class A Drivers License Yes NoDo you have a hazmat endorsement? Yes No No, but I have applied for onePHYSICAL EXAM EXPIRATION DATEJob 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. Current or Previous JobJob TitleCompany Phone NumberAddressStarting Date With The CompanyEnding DateWere you subject to the FMCSRs while employed here?- Select -YESNOWas 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?- Select -YESNOPrevious JobJob TitleStarting DateEnding DateWere you subject to the FMCSRs while employed here?- Select -YESNOWas 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?- Select -YESNOPrevious JobJob TitleStarting DateEnding DateWere you subject to the FMCSRs while employed here?- Select -YESNOWas 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?- Select -YESNOPrevious JobJob TitleStarting DateEnding DateWere you subject to the FMCSRs while employed here?- Select -YESNOWas 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?- Select -YESNOPrevious JobJob TitleStarting DateEnding DateWere you subject to the FMCSRs while employed here?- Select -YESNOWas 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?- Select -YESNOPrevious JobJob TitleStarting DateEnding DatePrevious JobJob TitleStarting DateEnding DateList any additional jobs hereHAVE YOU WORKED FOR THIS COMPANY BEFORE? Yes No IF yes, gives datesFromToReason for leaving?DRIVING EXPERIENCE Straight Truck Approximate dates driven FromApproximate dates driven ToApproximate Number of Miles Tractor & Semi- trailer Approximate dates driven FromApproximate dates driven ToApproximate Number of Miles Tractor & two trailers Approximate dates driven FromApproximate dates driven ToApproximate Number of Miles Tractor & triple trailers Approximate dates driven FromApproximate dates driven ToApproximate Number of Miles Other Approximate dates driven FromApproximate dates driven ToApproximate Number of MilesList states operated in, for the last five (5) years:List any Safe Driving Awards you hold and from whom:Accident Record Accident Record for past three (3) years: (attach sheet if more space is needed): Were you involved in ANY accidents in the past 3 years, even if a police report was NOT done? NO YES, if yes please full out form below Date of AccidentNature of AccidentsLocation of AccidentWas there a police reportDropdownNumber of People Injured- Select -01-22-34-55+Date of AccidentNature of AccidentsLocation of AccidentWas there a police reportDropdownNumber of People Injured- Select -01-22-34-55+Date of AccidentNature of AccidentsLocation of AccidentWas there a police reportDropdownNumber of People Injured- Select -01-22-34-55+Date of AccidentNature of AccidentsLocation of AccidentWas there a police reportDropdownNumber of People Injured- Select -01-22-34-55+Please list ANY additional accidents or incidents hereTraffic Convictions and Forfeitures for the last three (3) years (other than parking violations) NO YES, if yes please full out form below DateLocationChargePenaltyDateLocationChargePenaltyDateLocationChargePenaltyDateLocationChargePenaltyPlease list ANY additional Traffic Convictions and Forfeitures Driver’s License (list each driver’s license held in the past three(3) years StateLicense #Type/ClassEndorsementsExpiration StateLicense #Type/ClassEndorsementsExpiration StateLicense #Type/ClassEndorsementsExpiration StateLicense #Type/ClassEndorsementsExpiration StateLicense #Type/ClassEndorsementsExpiration Have you ever been denied a license, permit or privilege to operate a motor vehicle?- Select -YESNOHas Any License, Permit or Privilege Ever Been Suspended or Revoked?- Select -YESNOIs 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)?- Select -YESNOHave You Ever Been Convicted of a Felony?- Select -YESNOIf The Answers to Any Questions Listed Above Are “YES”, Give DetailsJob References List three (3) persons for references, other than family members, who have knowledge of your safety habits. NameAddressPhone NumberRelationship- Select -FriendCo-WorkerSpouseRelativeOtherNameAddressPhone NumberRelationship- Select -FriendCo-WorkerSpouseRelativeOtherNameAddressPhone NumberRelationship- Select -FriendCo-WorkerSpouseRelativeOther To Be Read 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 such 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. Apply