CDL applications - Arnold Oil Company

Name*

First Last

Email*

Phone*

Location*

Date you can start*

List your addresses of residency for the past 3 years.

Current Address*

Street Address City State ZIP Code

How long have you been at your current address?*

Previous Address 1

Street Address City State ZIP Code

Previous Address 1 How Long?*

Previous Address 2

Street Address City State ZIP Code

Previous Address 2 How Long? (yr./mo.)

Do you have the legal right to work in the United States?

Date of Birth

Can you provide proof of age? (Required for Commercial Drivers)

Have you worked for ARNOLD OIL COMPANY before?

Yes
No

Where?

Dates: From and To*

Rate of Pay

Position*

Reason for leaving

Are you now employed?

Yes
No

If not, how long since leaving last employment?*

Who referred you?*

Rate of pay expected

Have you ever been bonded?

Yes
No

Name of bonding company (Answer only if a job requirement)

Have you ever been convicted of a felony?

Yes
No

If yes, please explain fully (use back side if necessary). Conviction of a crime is not an automatic bar to employment all circumstances will be considered.

Is there any reason you might be unable to perform the functions of the job for which you have applied?

Yes
No

If yes, explain if you wish.

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, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate 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 1

Company Name

Company Address

City State ZIP Code

Date Employed from (Mth / Year): from and to

Contact Person

Phone Number

Position held:

Salary / Wage

Were you subject to the fmcsrs† while employed?

Yes
No

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
No

Reason for leaving

EMPLOYER 2

Company 2: Name

Company 2: Address

City State ZIP Code

Company 2: Date Employed from (Mth / Year): from and to

Company 2: Contact Person

Company 2: Phone Number

Company 2: Position held:

Company 2: Salary / Wage

Company 2: Were you subject to the fmcsrs† while employed?

Yes
No

Company 2: 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
No

Company 2: Reason for leaving

EMPLOYER 3

Company 3: Name

Company 3: Address

City State ZIP Code

Company 3: Date Employed from (Mth / Year): from and to

Company 3: Contact Person

Company 3: Phone Number

Company 3: Position held:

Company 3: Salary / Wage

Company 3: Were you subject to the fmcsrs† while employed?

Yes
No

Company 3: 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
No

Company 3: Reason for leaving

*Includes vehicles having a GVWR of 26,001 lbs. Or more, vehicles designed to transport 15 or more passengers, 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 9 or more passengers, 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 or More (Attach Sheet if more space is needed) IF NONE, WRITE NONE

Last accident dates

Last accident: nature of accident

HEAD-ON
REAR-END
UPSET, ETC.

Last accident: Fatalities

Last accident: Injuries

Last accident: Hazardous Material spill

Next previous accident: dates

Next previous accident: nature of accident

HEAD-ON
REAR-END
UPSET, ETC.

Next previous accident: Fatalities

Next previous accident: Injuries

Next previous accident: Hazardous Material spill

Next previous accident 2: dates

Next previous accident 2: nature of accident

HEAD-ON
REAR-END
UPSET, ETC.

Next previous accident 2: Fatalities

Next previous accident 2: Injuries

Next previous accident 2: Hazardous Material spill

EXPERIENCE AND QUALIFICATIONS – DRIVER

List all driver licenses or permits held in the past 3 years.

Driver licenses state

Driver licenses NO.

Driver licenses type

Driver licenses expiration date

Driver licenses 2: state

Driver licenses 2: Driver licenses NO.

Driver licenses 2: type

Driver licenses 2: expiration date

Driver licenses 3: state

Driver licenses 3: Driver licenses NO.

Driver licenses 3: type

Driver licenses 3: expiration date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes
No

B. Has 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 CIRCLE YES OR NO

Class of equipment: straight truck

Yes
No

Type of Equipment

DATES FROM(M/Y) TO (M/Y)

APPROX. NO. OF MILES (TOTAL)

Class of equipment: Tractor and semi-trailer

Yes
No

Tractor and semi-trailer: Type of Equipment

Tractor and semi-trailer: Dates from(m/y) to (m/y)

Tractor and semi-trailer: Approx. No. Of miles (total)

Class of equipment: Tractor – two trailers

Yes
No

Tractor – two trailers: Type of Equipment

Tractor – two trailers: Dates from(m/y) to (m/y)

Tractor – two trailers: Approx. No. Of miles (total)

Class of equipment: Tractor – three trailers

Yes
No

Tractor – three trailers : Type of Equipment

Tractor – three trailers: Approx. No. Of miles (total)

Tractor – three trailers: Dates from(m/y) to (m/y)

Class of equipment: Tractor – Motorcoach – school bus

Yes
No

Motorcoach – school bus : Type of Equipment

Motorcoach – school bus: Approx. No. Of miles (total)

Motorcoach – school bus : Dates from(m/y) to (m/y)

Class of equipment: Other

Yes
No

Class of equipment: Other : Type of Equipment

Class of equipment: Other: Approx. No. Of miles (total)

Class of equipment: Other : Dates from(m/y) to (m/y)

List states operated in for last five years:

Show special courses or training that will help you as driver:

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS – OTHER

Show any trucking, transportation or other experience that may help in your work for arnold oil company

List courses and training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

EDUCATION

High school

1
2
3
4

College

1
2
3
4

High school attended (name)

High school attended (city, state)

Trade, business or correspondence school (name)

Trade, business or correspondence school (city, state)

College (name)

College (city, state)

Degree earned:

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.

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

Signature of Applicant:*

Date

Print Name*

Consent

I agree to the privacy policy.

DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION

As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative
consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your
employment history. It may also include, but not limited to, credit information reports, criminal history reports and
driving history records. Under the provisions of the Fair Credit Report Act (15 USC at 1681-1681u) as amended,
before we can seek such reports, we must have your written permission to obtain the information. You have the right,
upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also
entitled to a copy of your Consumer Rights under the Fair Credit Reporting Act.

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION

Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq, the Americans with Disability
Act and all applicable federal, state, and local laws, I hereby authorize and permit ARNOLD OIL COMPANY to obtain
a consumer report and/or investigative consumer report which may include the following:

My employment records

Records concerning any driving, criminal history, credit history, civil records, worker’s compensation (post-offer
only) and drug testing;

(For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations;

Section 382.413, information concerning alcohol and controlled substance for the past two years;

Verification of my academic and/or professional credentials, and information and/or copies of documents from any military service records.

I understand that an “investigative consumer report” may include information as to my character, general reputation,
personal characteristics, and mode of living which may be obtained by interviews with individual with whom I am
acquainted or who may have knowledge concerning any such items of information

I agree that a copy of this authorization has the same effect as the original.

I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this
authorization, as well as ARNOLD OIL COMPANY from liability that might otherwise result from the request for use
of an/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of my
consumer report from the consumer reporting agency that compiled the report, after I have provided proper
identification.

I hereby authorize ARNOLD OIL COMPANY to obtain and prepare an investigative consumer report as set forth
above, as part of its investigation of my employment application.

Applicant’s signature*