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Employment Opportunities

Driver Information:

Name:

Address:

City:

State:

Zip:

E-mail:

Phone:

Date of Birth:

Miscellaneous Information:

Years of Experience:

Hazardous Materials Endorsement: yes no

Have you ever been convicted of a crime?
yes no If yes, explain:

Was your license ever suspended or revoked?
yes no If yes:

When:

Where:

Number of moving violations in the past 3 years:

Any accidents in the past 3 years?
yes no If yes:

When:

Who was at fault:

Damage amount:

Type of equipment and number of years operating each:

Intermodal:

Van:

Tanker:

Flatbed:

Other (& years):

Reference name:

Phone:

Current Emploment Information:

Current Employer:

City:

State:

Zip:

Phone:

Contact:

Position:

Employment Years:

Pay Rate:

Past Emploment Information:

Employer:

City:

State:

Zip:

Phone:

Contact:

Position:

Employment Years:

Pay Rate:

Why did you leave?

Employer:

City:

State:

Zip:

Phone:

Contact:

Position:

Employment Years:

Pay Rate:

Why did you leave?

I certify that I personally completed this application and that all information is true and correct. I authorize Big Daddy Drayage to conduct a thorough background investigation in accordance with state and federal law and authorize my previous EMs to release any information requested by Big Daddy Drayage and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current EMs specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provision of 49 CFR while in their employment, to Big Daddy Drayage by whatever means is most expedient.

I accept the certification terms: yes no

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