Contact us at: 801-520-7055

Employment Application

Nick Transport

COMMERCIAL DRIVER APPLICATION

Please fill out and submit the application form. We will review it and get back to you as soon as possible.

Applicant Information

(The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.)
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CURRENT & PREVIOUS THREE YEARS ADDRESSES:
From:
To:
From:
To:
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If yes, give dates:
From:
To:

Education History

Please Choose the highest grade completed:

Employment 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:
From:
To:
Position Held:
Address:
Reason for leaving:
Company phone:
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR) while employed here?
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?
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Present or Last Employer
From:
To:
Position Held:
Employer Address:
Reason for leaving:
Company phone:
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR) while employed here?
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?
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3 Present or Last Employer
From:
To:
Position Held:
Employer Address:
Reason for leaving:
Company phone:
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR) while employed here?
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?

Driving Experience

Straight Truck

From:
To:
Approximate Number of Miles

Tractor & Semitrailer

From:
To:
Approximate Number of Miles:

Tractor & Two Trailers

From:
To:
Approximate Number of Miles:

Tractor & Triple Trailers

From:
To:
Approximate Number of Miles:

Other

Driving Experience
List special courses/training completed

Accident Record for past three (3) years:

Date of Accident:
Nature of Accident
Location of Accident
Number of Fatalities
# of People Injured

Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations):

Date
Location
Charge
Penalty
Other Information

Driver’s License (list each driver’s license held in the past three(3) years:

State:
License #:
Type:
Endorsements:
Expiration Date:
Other licenses




Job References

List three (3) persons for references, other than family members, who have knowledge of your safety habits.

Name:
Address:
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Phone:
Name:
Address:
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Phone:
Name:
Address:
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Phone:

To Be Read and Signed 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.