DRIVER JOB APPLICATION
Are you 18 or older?
Are you a citizen of the United States?
Type of Position Applying for:
If not, are you legally allowed to work in the United States?
Have you ever worked for this company before
IF ANSWERED YES ABOVE, PLEASE FILL OUT SECTION BELOW:
Have you ever pleaded “guilty,” “no contest,” or been convicted of a crime?
Answering “yes” does not constitute an automatic rejection for employment. Date of offense, seriousness and nature of the violation,rehabilitation and position applied for will be considered.IF ANSWERED YES ABOVE, PLEASE FILL OUT SECTION BELOW:
Highest grade completed?
1 Year College
2 Years College
3 Years College
4 Years College
Start with the last or current position, including any military experience and work back. (attach a separate sheet if necessary)
Answer the questions in this section only if you are applying for a driver position.
The U.S. Department of Transportation requires that all driver applicants pass certain physical test before they are hired to drive a motor carrier.
Date of last Department of Transportation prescribed physical examination:
Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier SafetyRegulations pertaining to the loss of foot, leg, arm or hand?
Driver Licenses held in the past 3 years must be shown
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
B. Has any license, permit, privilege ever been revoked or suspended?
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?
Class of Equipment
Type of Equipment(Van, Tank, Flat, etc.)
Approximate Total Miles
Tractor and Semi-Trailer
List states operated in during the last 5 years
List special courses or training that will help you as a driver
List safe driving awards held and who awards were presented by
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquires in connection with my application.In the event I am employed, I understand that false and misleading information given in my application or interview(s) may result in discharge.I hereby consent to submit to urinalysis and/or other tests as shall be determined by McCoy Grading, Inc. in the selection process of applicants for employment, for the purpose of determining the drug content thereof.I agree that a lab designated by McCoy Grading, Inc. may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis.I agree that a diluted negative test result or any specimen that appears to be tampered with or suspicious will be treated as a positive test result and applicant will be responsible for the cost of the test, which is $110.00. The company will rely on the opinion of the testing laboratory as to the status of specimens submitted.I further agree to and hereby authorize the release of the results of said test to the company.I understand that it is the current use of illegal drugs that prohibits me from being employed at this company.I further agree to hold harmless the company and its agents (including the above named physician or clinic) from any liability arising in whole or part, out of the collection of specimens, testing, and us of the information from the said testing connection with the company’s consideration of my application of employment.I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.
Equal Employment OpportunityIn order to provide equal employment and advancement opportunities to all individuals, employment decisions at McCoy Grading, Inc. will be based on merit, qualifications, and abilities. McCoy Grading, Inc. does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristics protected by law.McCoy Grading, Inc. will make reasonable accommodations for qualified individuals with known disabilities, unless doing so would result in an undue hardship. This policy governs all aspects of employment, including selection, job assignment, compensation, discipline, termination, and access to benefits and training.Any employees with questions or concerns about any type of discrimination in the workplace are encouraged to bring these issues to the attention of their immediate supervisor. Employees can raise concerns and make reports without fear of reprisal. Anyone found to be engaging in any type of unlawful discrimination will be subject to disciplinary action, up to, and including, termination of employment.