Roaring Spring Water

Roaring Spring Water Driver Application Form

Driver Application PDF Download

  • 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 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 interviews(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 by 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 current/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 on the accuracy of the information
  • Applicant Information

  • Past 3 Year Residency

  • Employment History

    (Use Additional Employment History Information form if necessary)

    All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers who you have driven a commercial vehicle seven years prior to the initial three years (total of ten year employment record).

    You are required to list the complete mailing address: street number and name, city, state and zip code.

  • Current or Last Employer:

  • Second Last Employer:

  • Third Last Employer:

  • *Any gaps in employment and/or unemployment must be explained

    **The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

  • Experience and Qualification

  • Driving Experience

  • Straight Truck

  • Tractor & Semi-Trailer

  • Tractor - Two Trailers

  • Tractor - Three Trailers

  • Motorcoach - School Bus (Greater than 8 passengers)

  • Motorcoach - School Bus (Greater than 15 passengers)

  • Other:

  • Accident History (3 years)

  • Accident #1

  • Accident #2

  • Accident #3

  • Traffic Convictions and Forfeitures (3 years)

  • Traffic Conviction/Forfeiture #1

  • Traffic Conviction/Forfeiture #2

  • License Information

    Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do no have more than one motor vehicle license, the information for which is listed below.
  • Applicant Certification

    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.
  • Previous Pre-Employment Employee Alchohol and Drug Test Statement

    Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process. (see Sec. 40.25(b)(5) and (e))
  • The prospective employee is required by Sec. 40.25(j) to respond to the following questions.
  • I certify that the information provided on this document is true and correct.