Maine Oxy > Our Company > Careers > Driver Application

Driver Application

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Applicant information

First name(Required)

Last name(Required)

Phone number(Required)

Date of birth(Required)

Address

Street Address Address Line 2 City State ZIP Code

Number of years of residence

Address

Street Address Address Line 2 City State ZIP Code

Combined years of residence

Address

Street Address Address Line 2 City State ZIP Code

Consent(Required)

I agree to the following statement:

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, healthcare 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) 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 my safety performance history as required by 49CFR 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.”

Employment history

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 for whom 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 malling address, street number and name, city, state and zip code.

Current or last employer

Employer name(Required)

Phone number(Required)

Employer address(Required)

Street Address Address Line 2 City State ZIP Code

Position held(Required)

Start date(Required)

End date(Required)

Reason for leaving(Required)

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

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.

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?

Yes

Provide more employment history?(Required)

Yes

Any gap in employment and/or unemployment?(Required)

Yes

Please explain employment gap and/or unemployment(Required)

Any gaps in employment and/or unemployment must be explained.

Second last employer

Employer name(Required)

Phone number(Required)

Employer address(Required)

Street Address Address Line 2 City State ZIP Code

Position held(Required)

Start date(Required)

End date(Required)

Reason for leaving(Required)

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

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?

Yes

Provide more employment history?(Required)

Yes

Any gap in employment and/or unemployment?(Required)

Yes

Please explain employment gap and/or unemployment(Required)

Any gaps in employment and/or unemployment must be explained.

Third last employer

Employer name(Required)

Phone number(Required)

Employer address(Required)

Street Address Address Line 2 City State ZIP Code

Position held(Required)

Start date(Required)

End date(Required)

Reason for leaving(Required)

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

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?

Yes

Any gap in employment and/or unemployment?(Required)

Yes

Please explain employment gap and/or unemployment(Required)

Any gaps in employment and/or unemployment must be explained.

Experience and qualification

Do you have driving experience within the last 3 years?(Required)

Yes

Class of equipment(Required)

Please select all that apply

Straight truck

Tractor & semi-trailer

Tractor – two trailers

Tractor – three trailers

Motorcoach – School bus (greater than 8 passangers)

Motorcoach – School bus (greater than 15 passengers)

Other

Other(Required)

Describe driving experience:

Please list type of equipment (van, reefer, tank, or flat) and the dates of driving experience or approximate number of miles for each equipment type.

Do you have any accidents in the last 3 years?(Required)

Yes

Describe accident history(Required)

Please provide the date(s), nature of accident(s), number of any fatalities, number of any injuries, and if any hazardous materials were spilled for each event.

Do you have any traffic convictions and/or forfeitures in the last 3 years?(Required)

Yes

Describe traffic convictions and/or forfeitures(Required)

Please provide date(s), description of violation(s), the state of violation(s), and the penalty of each event.

State of license(Required)

License number(Required)

Expiration date(Required)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?(Required)

Yes

Please explain(Required)

Has any license, permit, or privilege ever been suspended or revoked?(Required)

Yes

Please explain(Required)

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.

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Comments

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Driver Application

Company information

Applicant information

Employment history

Current or last employer

Second last employer

Third last employer

Experience and qualification