Driver Application | TSK Transport LLC

Driver Employment Application

Fields marked * are required. Questions? Call 262-799-5090.

Applicant Information

Complete in full or it will not be considered. TSK Transport LLC is an Equal Opportunity Employer.

First nameMiddle nameLast namePhoneEmailDate of birthSocial Security #Date of applicationPosition applied forDate available for work

Do you have legal right to work in the United States? Yes No

Previous Three Years Residency

Current address

StreetCityStateZIP code# of years at address

Mailing address (if different)

StreetCityStateZIP code# of years at address

Previous address

StreetCityStateZIP code# of years at address

Previous address

StreetCityStateZIP code# of years at address

Previous address

StreetCityStateZIP code# of years at address

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). Include all licenses held for the past 3 years.

Current license

StateLicense #Type/ClassEndorsementsExpiration date

Previously held license 1

StateLicense #Type/ClassEndorsementsExpiration date

Previously held license 2

StateLicense #Type/ClassEndorsementsExpiration date

I certify that I do not have more than one motor vehicle license.

Driving Experience

Straight truck

Type of equipment (van, tank, flat, etc.)Date fromDate toApprox. # of miles (total)

Tractor & semi-trailer

Type of equipment (van, tank, flat, etc.)Date fromDate toApprox. # of miles (total)

Tractor & 2 trailers

Type of equipment (van, tank, flat, etc.)Date fromDate toApprox. # of miles (total)

Tractor & tanker

Type of equipment (van, tank, flat, etc.)Date fromDate toApprox. # of miles (total)

Other

Type of equipment (van, tank, flat, etc.)Date fromDate toApprox. # of miles (total)

Accident Record for the Past 3 Years No accidents in the past 3 years

List most recent first.

Accident 1

DateNature (head-on, rear-end, upset, etc.)# Fatalities# InjuriesChemical spills

Accident 2

DateNature (head-on, rear-end, upset, etc.)# Fatalities# InjuriesChemical spills

Accident 3

DateNature (head-on, rear-end, upset, etc.)# Fatalities# InjuriesChemical spills

Additional accidents (if more than 3)

Traffic Convictions and Forfeitures for the Past 3 Years No traffic convictions or forfeitures in the past 3 years (other than parking)

Conviction 1

Date convictedViolationState of violationPenalty (forfeited bond, collateral and/or points)

Conviction 2

Date convictedViolationState of violationPenalty (forfeited bond, collateral and/or points)

Conviction 3

Date convictedViolationState of violationPenalty (forfeited bond, collateral and/or points)

Additional convictions (if more than 3)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No

If yes, explain

Has any license, permit, or privilege ever been suspended or revoked? Yes No

If yes, explain

Employment History

49 CFR 391.21 requires all employment for the last 3 years; if you have previously driven a commercial vehicle, an additional 7 years (10 total). Explain any gaps over 1 month. Start with your current/most recent position, including military, and work backwards. Give complete mailing addresses.

Current (most recent) employer

NamePhoneAddress (street, city, state, ZIP)Position heldFrom (mo/yr)To (mo/yr)Reason for leavingSalaryExplain any gaps in employment (month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Yes No

Was the job a DOT safety-sensitive function subject to alcohol and controlled substances testing (49 CFR Part 40)? Yes No

Second most recent employer

NamePhoneAddress (street, city, state, ZIP)Position heldFrom (mo/yr)To (mo/yr)Reason for leavingSalaryExplain any gaps in employment (month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Yes No

Was the job a DOT safety-sensitive function subject to alcohol and controlled substances testing (49 CFR Part 40)? Yes No

Third most recent employer

NamePhoneAddress (street, city, state, ZIP)Position heldFrom (mo/yr)To (mo/yr)Reason for leavingSalaryExplain any gaps in employment (month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Yes No

Was the job a DOT safety-sensitive function subject to alcohol and controlled substances testing (49 CFR Part 40)? Yes No

Additional employers (to cover 3 / 10 years): name, phone, address, position, from–to, reason, salary, FMCSR Y/N, DOT testing Y/N

Education

High school

Name & locationCourse of studyYears completedGraduateDetails

College

Name & locationCourse of studyYears completedGraduateDetails

Other

Name & locationCourse of studyYears completedGraduateDetails

Other QualificationsPlease list any other qualifications you believe should be considered.

DocumentsCopy of CDL (front/back)Medical cardAdditional sheets (optional)

To Be Read and Signed by Applicant

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:

Review information provided by current/previous employers;
Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; 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.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

I have read and agree to the statement above.Applicant signature (type full legal name)DateApplicant name (printed)