Driver Application

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Thank you for your interest in employment with Johnson’s Wrecker Service, Inc. We are an Equal Opportunity Employer and Drug Free Workplace. All applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, military status or obligations.

INSTRUCTIONS AND INFORMATION
To be considered for employment, you must complete this application in full with true and correct information. Failure to do so may result in disqualification from consideration for hire or termination of employment if you are hired.

RE: Medical Examiner's Cetrificate - DOT Med Card

Dear Applicant

Please read and make sure you understand our driving requirements, before you proceed with completing the application.

In accordance with Federal Motor Carrier Safty Regualtions (49 CFR 391.41-391.49) all CDL license holders must obtain and self-certify with SLDA (State Driver's License Agency). We require a copy of the currnet DOT medical card to be kept in DOT personnel files.

**ALL Commerical Motor Vehicle drivers including non-CDL license holders are required to obtain and carry a medical card.**

You will be required to botain a new medical card and/or update an expired card BEFORE beginning work. If you have special requirements, exemptions, disabilities and/or need a referral, please discuss it at the time of your interview.

Thank you,

Johnson's Wrecker Service, Inc.

I have read and understand Johnson's meeker Service, Inc.'s policy regarding medical cards and further agree to obtain and/or update a medical card for myself and keep it updated with the Department of Motor Vehicles.

Please read and make sure you understand our driving requirements, before you proceed with completing the application.*

I have read and understand Johnson's Wrecker Service, Inc.’s policy regarding medical cards and further agree to obtain and/or update a medical card for myself and keep it updated with the Department of Motor Vehicles.

APPLICANT INFORMATION

Position(s) Applied for*

Name*

First Middle Last

Maiden / Other Names

Phone*

Email*

To which gender do you most identify?*

Race*

Current Address*

Street Address City State ZIP Code

How Long? (yr./mo.)

Previous Addresses*

Street

City

State & Zip Code

How Long? (yr./mo.)

Social Security No.*

Date of Birth*

MM slash DD slash YYYY

Do you have the legal right to work in the United States?*

Yes

Can you provide proof of age?*

Yes

Have you worked for this company before?*

Yes

Where?*

From*

MM slash DD slash YYYY

To*

MM slash DD slash YYYY

Rate of Pay*

Position*

Reason for leaving*

Are you now employed?*

Yes

If not, how long since leaving last employment?*

Who referred you?

Rate of pay expected*

Have you ever been bonded?

Yes

(Answer only if a job requirement)

Name of bonding company*

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?*

Yes

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 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

Employer Name*

From*

MM slash DD slash YYYY

To*

MM slash DD slash YYYY

Address*

Street Address Address Line 2 City State ZIP Code

Position Held*

Salary/Wage*

Contact Person*

Phone Number*

Reason for Leaving*

Were you subject to the FMCSRs+ while employed?*

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?*

Yes

Employer Name

From

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position Held

Salary/Wage

Contact Person

Phone Number

Reason for Leaving

Were you subject to the FMCSRs+ while employed?

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

Employer Name

From

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position Held

Salary/Wage

Contact Person

Phone Number

Reason for Leaving

Were you subject to the FMCSRs+ while employed?

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

Employer Name

From

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position Held

Salary/Wage

Contact Person

Phone Number

Reason for Leaving

Were you subject to the FMCSRs+ while employed?

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

Employer Name

From

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position Held

Salary/Wage

Contact Person

Phone Number

Reason for Leaving

Were you subject to the FMCSRs+ while employed?

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

Employer Name

From

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position Held

Salary/Wage

Contact Person

Phone Number

Reason for Leaving

Were you subject to the FMCSRs+ while employed?

Yes

Was your job designated a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?

Yes

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vel1icle used to transport hazardous materials in a quantity requiring placarding.

+Title Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENTS & CONVICTIONS

Accident record for past 3 years or more (attach sheet if more space it needed) If none, write none*

Date

Nature of Accident

Fatalities

Injuries

HAZMAT Spill

Traffic conviction and forefeitures for the past 3 years (other than parking violations) if non, write none*

Location

Date

Charge

Penalty

(Attach sheet if more space is needed)

EXPERIENCE AND QUALIFICATIONS - DRIVER

Driver licenses or permits held in the past 3 years*

State

License No.

Class

Endorsements

Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

Yes

B. Has any license, permit or privilege ever been suspended or revoked?*

Yes

IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS*

DRIVING EXPERIENCE

STRAIGHT TRUCK*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

TRACTOR AND SEMI-TRAILER*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

TRACTOR - TWO TRAILERS*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

TRACTOR - THREE TRAILERS*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

MOTORCOACH-SCHOOLBUS*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

OTHER*

Yes

CIRCLE TYPE OF EQUIPMENT

DATES FROM (M/Y) TO (M/Y)

APPROX. NO. OF MlLES (TOTAL)

LIST STATES OPERATED IN FOR LAST FIVE YEARS*

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER*

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM*

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)

EDUCATION

HIGHEST GRADE COMPLETED*

High School 1

High School 2

High School 3

High School 4

College 1

College 2

College 3

College 4

LAST SCHOOL ATTENDED (NAME)*

Driver Availability

Johnson's Wrecker Service, Inc. is open 24 hours per day, 7 days per week, and 365 days per year. The purpose of this form is to establish your working availability. The information you provide will help determine the location for your placement. Please be accurate and specific when providing the days and times you are available. Applicants with the greatest availability will be given first consideration. Your availability does not constitute an offer of employment or a schedule agreement. All shifts are scheduled based on the needs of the business and may change as needed.

This form is NOT a schedule request form. Please only indicate specific dates/times you cannot work. If you are hired and need to change your availability, you acknowledge that we may or may not be able to accommodate the changes. You will also be responsible for updating this form if your availability changes.

I am available to start work on*

MM slash DD slash YYYY

Availability

I am fully available to work any days/hours

I am NOT available to work the following days/hours:

Once hired, to request days off, please use the Request for Time Off forms located at Dispatch or HR Office.

Monday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Tuesday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Wednesday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Thursday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Friday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Saturday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Sunday

From

Hours

Minutes

AM/PM

Hours

Minutes

AM/PM

Front of Drivers License*

Max. file size: 256 MB.

Back of Drivers License*

Max. file size: 256 MB.

Other Files*

Drop files here or

Max. file size: 256 MB.

Certification*

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.

Signature*

Date*

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

Mon	8:00am – 6:00pm
Tues	8:00am – 6:00pm
Wed	8:00am – 6:00pm
Thurs	8:00am – 6:00pm
Fri	8:00am – 6:00pm
Sat	8:00am – 5:00pm
Sun	Closed

Mon	Open 24 Hours
Tues	Open 24 Hours
Wed	Open 24 Hours
Thurs	Open 24 Hours
Fri	Open 24 Hours
Sat	Open 24 Hours
Sun	Open 24 Hours

Driver Application

APPLICANT INFORMATION

EMPLOYMENT HISTORY

ACCIDENTS & CONVICTIONS

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVING EXPERIENCE

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION

Driver Availability

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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