Texas CDL Driver Application




Three-year history is required on residence.

Experience And Qualifications – Driver

Licenses for the past 3 years



Experience

Driving Experience

Accident History

Traffic Convictions And Forfeitures For The Past Three Years (Other Than Parking Violations)


In the past three years, have you ever tested positive for a controlled substance, had an alcohol test with concentration of .04 or greater, or refused a drug or alcohol test?

If yes, explain:

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Has any license, permit, or privilege ever been suspended or revoked?

If yes, explain:

Have you ever been convicted of a felony?
YesNo
Have you worked for this company before? YesNo

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, you are being informed that reports verifying your previous employment, previous drug & alcohol tests, 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. Under the driver’s Privacy Protection Act of 1994(Public Law103-322, Title XXX, Section 300002(a), we will adhere to the Definition of permissible uses and purposes.

I understand and agree to this disclosure.YesNo
I agree to abide by the safety rules of this company. I understand adherence is a Condition of employment and continued employment.
YesNo

I authorize my employer to use best judgment for treatment unless I instruct otherwise.YesNo

I understand pre-employment, post-accident, and random drug testing is required. YesNo


Please read the following prior to signing this application:
I declare that I understand all questions and statements on this application and that I have answered all questions accurately and to th ebest of my knowledge. I understand that the omission or misrepresentation of any fact in this application for employment will be sufficient reason to be denied employment. I also understand and agree that should I become employed and it is later discovered I have omitted or misrepresented any fact in this application, or any supplement thereto, or any other record, employment will immediately be terminated upon such discovery.

I understand that information I supply regarding current and/or previous employers will be used and those employer(s) will be contacted to investigate my safety performance history. I understand I have the right to:

Review information provided by previous employer(s).
Have errors corrected by previous employers and have this information resubmitted.
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.
I have read the above and understand it. YesNo

Applicant Initials:

Employment History Portion Of The Application

From the date of this application, please list the names of all previous employers for the entire preceding 10-year period. Be sure that all addresses and phone numbers are listed and are accurate. Please check all previous employers where you worked as a CDL driver or other safety sensitive position subject to DOT drug & alcohol testing. (Make sure you put complete addresses for all employers)

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

CDL driver or safety sensitive position: YesNo

I hereby authorize you as my Current/Former Employer, to release the following information to Rip Griffin Truck Service Center, Inc., Pro Petroleum Inc. and Subsidiaries per 49 CFR Part 40, all DOT regulated drug and alcohol testing records as well as my previous employment and safety records. This information may include, but is not limited to, prior controlled substance and alcohol testing results, driving record for the past three years, employment data, personal characteristics, safety history, and any other information relevant to determine my performance and safety
background.

DOT requires previous employers to verify employment history and requires former employers to provide the required information in turn. This company reports non-compliance to DOT.

Applicant’s Name
Applicant’s SS#