TTI - transportation services, trucking company, LTL carrier, flatbed, van, reefer trucking

Online Application

Please send in a copy of your CDL license after submitting this application.

Dear Applicant: Per FMCSR 391.21 (d) Before an application is submitted, the motor carrier shall inform the applicant that the information he/she provides for the employment history may be used, and the applicant’s prior employers may be contacted, for the purpose of investigating the applicant’s safety performance history information. The prospective employer must also notify the driver in writing of his/her due process rights as specified in § 391.2(i) regarding information received as a result of these investigations. You the applicant have the following rights: (i) The right to review information provided by previous employers; (ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (iii) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

PERSONAL INFORMATION

Driver Applicant Name:

Driver Applicant Signature:

Date:

Position(s) Applied For:

Van Driver Flatbed Driver Stepdeck Driver

Last Name:

First Name:

Middle Name/Initial:

Social Security Number:

Address:

City:

State:

Zip:

Phone:

Address for Past Three Years:
Address: City: State & Zip: How Long?

Address: City: State & Zip: How Long?

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

Date of Birth:

/ /

Can you provide proof of age?

In case of emergency, notify:

Name:
Address:
Phone:

Have you worked for this
company before?

If yes...

Where:
Dates:	From To
Rate of Pay:
Position:
Reason for Leaving:

Are you now employed?

If not, how long since
leaving last employment?

Who referred you?

Rate of pay expected:

TRUCK DRIVER JOB DESCRIPTION

Driver is required to be knowledgeable and skilled in loading trailer, securing the load, and driving a semi-truck with trailer. Driver is responsible for performing pre-trip and post-trip vehicle inspections, keeping log on miles, filling out trip reports, etc. Filling fuel tanks, hook and unhook trailers, and performing preventative maintenance inspections.

Are you capable of the above job description?
Are you physically capable of lifting 50 pounds over your head?
Are you physically capable of listing 50 pounds repetitively?
Are you physically capable of sitting and driving for long periods of time?
If applying for flatbed driver position, are you physically capable of pulling chain binder?
If applying for van driver position, are you physically capable of shutting van trailer doors?
Would you be willing to take a pre-placement physical examination?
Would you be willing to take a pre-placement drug test?
Do you have any pending convictions or charged against you?

DRIVERS APPLICATION FOR EMPLOYMENT

EMPLOYMENT RECORD Complete all data for EACH last employer COMPLETELY. The U.S. Department of Transportation requires that the driver applicants show all employment for the past three years. Effective July 1, 1987, they must also show commercial driver employment for the seven years preceding this three year period. Sec. 291.21 (b) (10) 911). Account for any gaps in employment between employers.

LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

SECOND LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

THIRD LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

FOURTH LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

FIFTH LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

SIXTH LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

SEVENTH LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

EIGHTH LAST EMPLOYER
Name:
Address:
City:
State:
Zip:
Phone:	()
Dates:	From: / / To: / /
Position Held:
Type of Equip. Driven:
Areas Driven in:
Reason for Leaving:
Yes No	Were you regulated by FMCSA during this job?
Yes No	Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?

ACCIDENT RECORD OF PAST 10 YEARS OR MORE (Attach sheet if more space is needed.)
DATES	NATURE OF ACCIDENTS (Head-on, rear-end, upset, etc.)	FATALITIES	INJURIES
Last Accident:
Next Previous:
Next Previous:
Next Previous:
Next Previous:

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 10 YEARS (Other than parking violations.)
DATES	NATURE OF ACCIDENTS (Head-on, rear-end, upset, etc.)	FATALITIES	INJURIES
Last Accident:
Next Previous:
Next Previous:
Next Previous:
Next Previous:

EDUCATION
Check highest grade completed. Elementary School: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4 Last School Attended: City:

EXPERIENCE AND QUALIFICATIONS – DRIVER
DRIVER LICENSES	STATE	LICENSE NO.	TYPE	EXPIRATION DATE

Yes No	Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes No	Has any license, permit or privilege ever been suspended or revoked?
Yes No	Have you ever been convicted of a felony?
Yes No	Have you ever been convicted of a DWI/OWI?
Yes No	Have you tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
Yes No	If the answer is yes, did you go to a substance abuse professional for an evaluation?
	IF YES TO ANY ANSWER ATTACH STATEMENT GIVING DETAILS!

DRIVING EXPERIENCE - FOR THE PAST TEN YEARS
CLASS OF EQUIPMENT	TYPE OF EQUIPMENT (Van, Tank, Flat, Etc.)	DATES FROM TO	APPROX. NO. OF MILES (Total)
Straight Truck
Tractor & Semi-Trailer
Tractor - Two Trailers
Other

List states operated in for last five years.

Show special courses or training that will help you as a driver.

Which safe driving award do you hold and from whom?

List flatbed experience for the past 10 years.

List van experience for the past 10 years.


EXPERIENCE AND QUALIFICATIONS – OTHER
Show any trucking, transportation or other experience that may help in your work for this 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).

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. 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. I hereby release employers, schools or persons from all liability in responding to inquiries 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, as permitted by Law.

Enter Your Full Name for Signature: Date:

REQUEST FOR CHECK OF DRIVING RECORD

I hereby authorize you to release DRIVING RECORD INFORMATION to T.T.I. Inc. for purposes of investigation as required by Sections 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.

Enter Your Full Name for Signature: Date:

REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER

I hereby authorize you to release the employment/driving/accident information to T.T.I., Inc. for the purpose of investigation as required by Section 391.23 and 382.405 and 40.25 and 382.413 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may result from furnishing such information. I also realize I may not be offered a job based on information from this report.

Enter Your Full Name for Signature: Date: / /
Social Security Number: - -

Please send in a copy of your CDL license after submitting this application.

Mail to:
TTI Inc.
PO Box 188
Eden, WI 53019

TTI Inc. • P.O. Box 188, Eden, Wisconsin, 53019 • Phone 800-558-2664