Employment Application Driver’s Application for Employment Applicant Name Date of Application MM slash DD slash YYYY In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group status. To be read and signed by Applicant 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. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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, also, that I am required to abide by all rules and regulations of VIP Vegas Limousine LLC, dba/ All Time Limo. I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to: Review information provided by previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send 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.Applicant SignatureDate MM slash DD slash YYYY By signing above you are authorizing VIP Vegas Limousine, LLC dba/All Time Limo to perform the necessary inquiries described in the statement above.Applicant to CompletePosition(s) Applied for Name Last four Social Security NoPlease enter a number greater than or equal to 0.List your addresses of residency for the past 2 years Current Address STREET ZIP CITY Phone Duration YR MO Street CITY ZIP Do you have the right to work in the United States? Date of Birth MM slash DD slash YYYY Can you provide proof of age? Have you worked for All Time Limo before? If yes when DatesFrom MM slash DD slash YYYY T0 MM slash DD slash YYYY Rate of PayPosition Reason for leaving Are you now employed? If not, how long since leaving last employment? Who referred you? Rate of pay expectedHave you ever been convicted of a felony? If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment circumstances will be considered.Is there any reason you might not be able to perform the functions of the job to which you have applied [as described in the attached job description]? 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 10 years. List complete mailing address, street numbers, city, state, and zip code.Employer To Month Year From Month Year Position Held Address Salary/wageCity State Zip Reason for Leaving Contact Person Phone NumberWere you subject to the FMCSRs (Federal Motor Coach Safety Regulations) while employed?YesNoWere you subject to DOT-regulated drug and alcohol testing at your last place of employment (rule 49 CFR 40)?YesNoEmployer From Month Year ToMonth Year Position Held Address Salary/wage City State Zip Reason for Leaving Contact Person Phone NumberWere you subject to the FMCSRs (Federal Motor Coach Safety Regulations) while employed?YesNoWere you subject to DOT-regulated drug and alcohol testing at your last place of employment (rule 49 CFR 40)?YesNoAccident Record for the past 3 years or more (attached sheet if more space is needed) if none, write none, Dates Nature of accident Fatalities Injuries Hazardous Material Spill (Head-on, rear-end, ECT.)Last Accident Next Previous Next Previous Traffic Convictions and forfeitures for the past 3 years (other than parking violations) if none, write noneLocation Date MM slash DD slash YYYY Charge Penalty (attach sheet if more space is needed)Experience and Qualifications—DriverList all driver's licenses or permits held in the past 10 yearsState License NO Type Exp Date MM slash DD slash YYYY Have you ever been denied a license, permit, or privilege to operate a motor vehicle?YesNoHas any license, permit, or privilege ever been suspended or revoked?YesNoIf the answer to either A or B is yes, give detailsDriving Experience check yes or no Straight TruckYesNoFrom (M/Y) MM slash DD slash YYYY To(M/Y) MM slash DD slash YYYY Approx. No. of milesTractor and semi-trailerYesNoFrom (M/Y) MM slash DD slash YYYY To(M/Y) MM slash DD slash YYYY Approx. No. of milesMotorcoach-School BusYesNoFrom (M/Y) MM slash DD slash YYYY To(M/Y) MM slash DD slash YYYY Approx. No. of milesMore than 8 Pass More than 15 Pass Other List States operated in for last five years:List Special courses or training that help you as a driver:Circle Highest Grade Completed:12345678High School:1234College:1234To be Read and Signed by Applicant This certifies that this applicant was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.SignaturePrint Name: Date MM slash DD slash YYYY CAPTCHA DOWNLOAD PDF FORM
