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APPLICANT INFORMATION

Name*
Email Address*
Phone Number*
Date of Birth
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Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date Available For Hire
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Have You Worked for Downey Trucking Before?
Are You Currently Employed?
Education (Years Completed)
Have you been convicted of a misdemeanor or felony? If yes, please explain...
- Yes
- No
Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.
Physical History
The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) require that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.
Alcohol and Controlled Substance Statement
The Federal Motor Carrier Safety Regulations require all persons applying for a driving position requiring a commercial drivers license to answer the following questions:
Driver's License Information
The past three years must be shown below...
State (Current) Type (Current) Expiration Date (Current)
Driving Experience Accident History

The past three years must be shown below...
Motor Vehicle Driving Record

Traffic Convictions and Forfeitures for the past 3 years other than parking violations...
Employment History
The Federal Motor Carrier Safely Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.
Current or Most Recent Employer
Employer contact Phone Number
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving
Supervisor's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Second Most Recent Employer
Employer contact Phone Number
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving
Supervisor's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Third Most Recent Employer
Employer contact Phone Number
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving
Supervisor's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fourth Most Recent Employer
Employer contact Phone Number
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving
Supervisor's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fifth Most Recent Employer
Employer contact Phone Number
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving
Supervisor's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I understand Downey Trucking may contact me by phone to obtain sensitive information (Social Security Number) required for background checks, etc...
- Yes
- No
I have read the DISCLOSURE, AUTHORIZATION, and NOTICE below regarding background reports provided to me by Downey Trucking, and I understand that if I sign this Disclosure and Authorization, Downey Trucking may obtain a report of my crash and inspection history. I hereby authorize Downey Trucking and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
- Yes
- No
Today's Date
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APPLICANT INFORMATION

Driver's License Information

Employment History