* = Required Information
STALLION LOGISTICS, LLC
800-294-3865
All fields are required
DRIVER'S APPLICATION FOR EMPLOYMENT
In compliance with Federal and Provincial equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, colour, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

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, health care 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 49 CFR 391.23(d) and (e). I understand that I have the right to:
  • Review information provided by 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 attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Name Date
PHYSICAL HISTORY
Yes No
Yes No
Yes No
APPLICANT TO COMPLETE
(answer all questions)
List your addresses of residency for the past 3 years.
Current Address
Previous Address
  
  
(Required for Commercial Drivers)
Dates
(Answer only if a job requirement)
Yes No
EMPLOYMENT HISTORY
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, province and Postal Code. Applicants to drive a commercial motor vehicle* in interstate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.
EMPLOYER DATE
Name From To
City Province
Postal Code Position Held
Contact Person Salary Wage
Phone Number Reason for leaving
Where you subject to the FMCSRs? While Employed? Yes No
Was your job designated as a safety-sensitive function in any dot-related mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes No
EMPLOYER DATE
Name From To
City Province
Postal Code Position Held
Contact Person Salary Wage
Phone Number Reason for leaving
Where you subject to the FMCSRs? While Employed? Yes No
Was your job designated as a safety-sensitive function in any dot-related mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes No
EMPLOYER DATE
Name From To
City Province
Postal Code Position Held
Contact Person Salary Wage
Phone Number Reason for leaving
Where you subject to the FMCSRs? While Employed? Yes No
Was your job designated as a safety-sensitive function in any dot-related mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes No
EMPLOYER DATE
Name From To
City Province
Postal Code Position Held
Contact Person Salary Wage
Phone Number Reason for leaving
Where you subject to the FMCSRs? While Employed? Yes No
Was your job designated as a safety-sensitive function in any dot-related mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes No
EMPLOYER DATE
Name From To
City Province
Postal Code Position Held
Contact Person Salary Wage
Phone Number Reason for leaving
Where you subject to the FMCSRs? While Employed? Yes No
Was your job designated as a safety-sensitive function in any dot-related mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes No
*Includes vehicles having a GVWR of 26, 001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver) or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
*The Federal Motor Carrier Safety Regulations (FMCSRs) 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 more than 8 passengers (including the driver), OR 3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, TYPE NONE
Dates Nature of Accident (HEAD-ON, REAR-END, UPSET, ETC) Fatalities Injuries Hazardous Material Spill
Last Accident
Next Previous
Next Previous
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, TYPE NONE
Location Date Charge Penalty
EXPERIENCE AND QUALIFICATIONS - DRIVER
List all driver licenses or permits held in the last 3 years.
Driver License Province License No. Type Expiration Date
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes No
B. Have any license, permit or privilege ever been suspended or revoked?
Yes No
If the answer to either A or B is yes, give details
Driving Experience check Yes or No
CLASS OF EQUIPMENT TYPE OF EQUIPMENT DATES APPROX. NO. OF MILES (TOTAL)
Straight Truck
Yes No
VanTankFlatDumpReefer From
To
Tractor and Semi Trailer
Yes No
VanTankFlatDumpReefer From
To
Tractor - Two Trailers
Yes No
VanTankFlatDumpReefer From
To
Tractor - Three Trailers
Yes No
VanTankFlatDumpReefer From
To
Motorcoach School Bus
Yes No
VanTankFlatDumpReefer From
To
(MORE THAN 8 PASSENGERS)
Motorcoach School Bus
Yes No
From
To
(MORE THAN 15 PASSENGERS)
Other From
To
EXPERIENCE AND QUALIFICATIONS - OTHERS
EDUCATION
12345678
1234
1234
TO BE READ AND SIGNED BY APPLICANT
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.