Driver & Owner Operator Application
Please fill out all the information below

Validation Information
   
Date of Application: Tuesday 06th of January 2009
Full Name:
Date of Birth:
SSN:
Phone :
Secondary Phone:
Email:
 
Driver Information
   
List of residency for the past 3 years:
 
License State:
License Number:
Endorsements:
Years of Verifiable Experience:
 
Position Applying For:
 
Who Referred You?
 
 
Driving History
   
Number of moving violations in the past 3 years:
 
Number of accidents in the past 5 years:
 
Has your license ever been suspended?
 
Have you ever been convicted of a crime?
 
If yes, explain:
 
Have you ever tested positive for drugs/alchohol, or refused drug/alcohol testing?
 
 
Work History
   
Current or Recent Employer
Company Name:
From:
(MM/DD/YYYY)
To:
(MM/DD/YYYY)
May we contact this employer?
 
Street Address:
City:
State:
Zip:
Phone:
Supervisor's Name:
 
Position:
Type of Equipment Driven:
 
Reason for leaving:
 
Were you subject to the FMCSRs while employed?
 
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?
 
 
 
Second Previous Employer
Company Name:
From:
(MM/DD/YYYY)
To:
(MM/DD/YYYY)
May we contact this employer?
 
Street Address:
City:
State:
Zip:
Phone:
Supervisor's Name:
 
Position:
Type of Equipment Driven:
 
Reason for leaving:
 
Were you subject to the FMCSRs while employed?
 
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?
 
 
 
Third Previous Employer
Company Name:
From:
(MM/DD/YYYY)
To:
(MM/DD/YYYY)
May we contact this employer?
 
Street Address:
City:
State:
Zip:
Phone:
Supervisor's Name:
 
Position:
Type of Equipment Driven:
 
Reason for leaving:
 
Were you subject to the FMCSRs while employed?
 
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?
 
 
 
Fourth Previous Employer
Company Name:
From:
(MM/DD/YYYY)
To:
(MM/DD/YYYY)
May we contact this employer?
 
Street Address:
City:
State:
Zip:
Phone:
Supervisor's Name:
 
Position:
Type of Equipment Driven:
 
Reason for leaving:
 
Were you subject to the FMCSRs while employed?
 
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?
 
 
 
Fifth Previous Employer
Company Name:
From:
(MM/DD/YYYY)
To:
(MM/DD/YYYY)
May we contact this employer?
 
Street Address:
City:
State:
Zip:
Phone:
Supervisor's Name:
 
Position:
Type of Equipment Driven:
 
Reason for leaving:
 
Were you subject to the FMCSRs while employed?
 
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?
 
 
   

SUBMISSION ACKNOWLEDGEMENT

I authorize Zamco Transport Specialists, Inc. (Prospective Employer) to conduct a thorough background investigation in accordance with Section 391.23 of the Federal Motor Carrier Safety Regulations and authorize my previous employers to release any information requested by Zamco Transport Specialists, Inc. and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Zamco Transport Specialists, Inc. by whatever means is most expedient.

I understand that any offer of employment is contingent upon my ability to produce documentation verifying my identity and legal authorization to be employed, as required by the Immigration Reform & Control Act of 1986 (IRCA).

This application is active for sixty (60) days from the date it is completed, or until the specific position opening for which it was submitted is closed, whichever is earlier. Subsequent to the preceding consideration period, I must submit a new application to be considered for this, or any other position.

I have read carefully the above information, understand and accept the contents thereof. 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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