Welcome To Holiday Express Corporation A 48 State Transportation Company

Driver's Application For Employment

APPLICANT TO COMPLETE

Position(s) Applied for:

Name:

SSN: (no dashes or spaces, please)

Current Address 1:
Address 2:

City: State: Zip Code:

Home Phone Number: How Long? yr/mo.

List your addresses of residency for the past 3 years

Street	City	State & Zip	How Long? yr/mo.

Email Address (if applicable):

TRUCKING EXPERIENCE: OTR Years
SOLO TEAM REEFER STATES

Do you have the legal right to work in the United States? Yes No

Date of Birth: Age:
Can you provide proof of age? Yes No

Have you ever worked for this company before? Yes No

If yes, Where? Dates: From To:

Rate of Pay Position:

Reason for leaving:

Are you employed now? Yes No
If not, how long since leaving last employment?

Who referred you? Rate of pay expected:

Have you ever been bonded? Yes No
Name of bonding company

Have you ever been convicted of a felony? Yes No

If yes, please explain fully by emailing us. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.

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 No

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 preceeding 10 years. List complete mailing address, street number, city, state and zip code.
(NOTE: List employers in reverse order starting with the most recent. Email additional if necessary.)

Current or Most Recent Employer

Company Name:

Address 1:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Held: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 1

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Pay Rate:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 2

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 3

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 4

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 5

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 6

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

Previous Employer 7

Company Name:

Address 1:

Address 2:

City: State: Zip:

Contact Person: Phone:

Employment From: to

Position Title: Salary/Wage:

Reason for Leaving:

Were you subject to the FMCSRs+ while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
Yes No

*Includes vehicle having a GVWR of 26,0001 lbs. or more, vehicle designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

+The 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 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD - For past 3 years or more.

DATES	NATURE OF ACCIDENT Head-on, Rear-end, upset, etc.	FATALITIES	INJURIES	HAZARDOUS MATERIAL SPILL

TRAFFIC CONVICTIONS and forfeitures for the past 3 years (other than parking violations), if none, type none.

Location	Date	Charge	Penalty

Email us if more space is needed

EXPERIENCE AND QUALIFICATIONS - DRIVER
List all driver licenses or permits held in the past 3 years

Driver Licenses	State	License No.	Type	Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

B. Has any license, permit or privilege ever been suspended or revoked?
Yes No

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

DRIVERS EXPERIENCE

Class of Equipment		Choose type of equipment	Dates From - To	Approx. No. of miles (total)
Straight Truck	Yes No
Tractor & Semi-trailer	Yes No
Tractor-Two Trailers	Yes No
Tractor- Three Trailers	Yes No
Motorcoach-School Bus more than 8	Yes No	--
Motorcoach-School Bus more then 15	Yes No	--
Other

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

Select highest grade completed: High School: College:

Last school attended: Name City; State:

Three Personal References, other than relative:

Name	Workday Telephone#

How did you hear about this company?
Referred by:

IN CASE OF EMERGENCY NOTIFY: Name Address
City/State Phone
Relationship

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.

I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires 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 an other persons from all liability in responding to inquires and releasing information 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.

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 CPR391.23(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.

TO BE READ AND SIGNED BY APPLICANT

By entering your name in this field, you indicate that the contents of this
application to be true to the best of your knowledge. Your signature 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 your knowledge.
(signature)

PLEASE MAIL OR FAX THIS FORM AFTER FILLING OUT ONLINE APPLICATION
Must be filled out and mailed or faxed in order for application to be complete.