Brannan Paving Company, LTD
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Brannan Paving Co., Ltd.

DRIVER'S APPLICATION FOR EMPLOYMENT

It is the policy of Brannan Paving Co. Ltd., to assure that applicants are employed, and that employees and applicants for employment are treated fairly and to provide equal employment opportunity to all employees and applicants for employment and not to discriminate on any basis prohibited by law, including race, color, sex, age, religion, national origin, disability, age, sexual orientation, gender or gender conformity, marital status or veteran status. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre-apprenticeship, and/or on-the-job training.

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. (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 further understand that if I am employed, it will be "AT WILL", subject to termination at any time by either party, with or without notice.

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 [including ACCIDENT INFORMATION AND DRUG/ALCOHOL TESTING INFORMATION] as required by Federal Motor Carrier laws. 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 employers; 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.

List your addresses for the past 3 years.


Proof of identity and eligibility will be required upon employment.

Note: A conviction will not necessarily result in denial of employment.

IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS

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, state and zip code.

Applicants to drive a commercial motor vehicle* in interstate or intrastate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle(s). NOTE: List employers in reverse order stating with the most recent; add another sheet if necessary.

PROFESSIONAL EXPERIENCE
(Start with your present or most recent position. Use an additional sheet of paper if more space is needed).

Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including driver) of 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 driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.


ACCIDENT RECORD FOR THE PAST 3 YEARS If None, write "None"
Dates Nature of Accident (head-on, rear-end, upset, etc.) Fatalities Injuries Hazardous Material Spill
Last Accident:
Next Previous:
Next Previous:
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TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS). If none, write "None"
Location Date Charge Penalty


DRIVER LICENSES OR PERMITS HELD IN THE PAST 3 YEARS
State License No. Class Endorsement(s) Expiration Dates


DRIVING EXPERIENCE (Check Yes or No)
Class of Equipment Type Dates
From (MY/) To (MY/)
Approx # of Miles (Total)





















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IMPORTANT, PLEASE READ AND SIGN: I understand that failure to reveal any prior employer, or giving false or misleading information by me on any part of this Application for Employment can be grounds for termination from the company. I understand that if I am employed, my employment is "AT WILL" and is for no definite time and may be terminated by the company or me at any time without prior notice.