Employment

The Civil Rights Act of 1964 prohibits discrimination because of race, color, religion, sex or national origin. PL90-202 prohibits discrimination because of age. Read and complete all portions of this form.

Thank you for considering Jersey Cartage/ US Logistics to be your employer. We understand that the information you provide us on this application is very sensitive and want you to know that we will safeguard this information and only use it as necessary to meet the Department of Transportation and Jersey Cartage's requirements. NON-DRIVER APPLICATION

PROFESSIONAL DRIVER APPLICATION

Personal Information

First Name: Middle:Last Name:
Home Phone Cell Phone Email Address
Date of Birth        

List Current Address and Others in the Past 5 Years

  Street City State Zipcode How Long?
Current:
 
 
 
 

List All Driver's License Held By You In The Last 5 Years

State License Number CDL Class Endorsements Exp. Date

Education

Select years completed from each level of education

Grade School High School College Do You Have:

List Any Training Programs Presently Attending Or Completed (Truck Driving or Service School)

Name City State Phone Number

Military Service Record

Have You Ever Served in the US Armed Forces? Branch Date From (mm/yyyy) Date To (mm/yyyy)
Highest Rank Achieved Rank at Discharge    
   
List any skills learned during military service that would help you qualify for this position

Motor Vehicle Accident Record (If none, write "None")

List all accident involvement with any motor vehicle during the past 5 years, even if you were not at fault

Date of Accident Type of Vehicle Nature of Accident
(Rear-End, Upset, Etc.)		 At fault? Ticketed? # of Injuries # of Fatalities $ Amount of Property Damage

Motor Vehicle Traffic Convictions (If none, write "None")

List all traffic convictions and forfeitures during the past 5 years for any motor vehicle, other than Parking Tickets.

Date State Name of Violation (If speeding, show rate of speed) Amount of Fine

Personal References

List 2 people to verify your employment and personal history, such as coworkers, friends or neighbors.
DO NOT USER RELATIVES OR FORMER EMPLOYERS

Name City State Zipcode Phone Occupation Place of Employment Time Known

Emergency Notification

IN CASE OF AN EMERGENCY, NOTIFY THE FOLLOWING PERSON

Name Street City State Zipcode Phone Relationship Occupation

Personal History For Past 10 Years

Begin with your present experience and work backward in order, listing all of your employers, driving school and other training programs, periods of military service, self-employment and unemployment for at least 10 years. All time must be accounted for. Fill in all blanks. Leave NO blanks or gaps in time for past 10 years.

Present or Most Recent Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
May we contact your present employer (if any) to verify work record
Period of Unemployment (mm/yyyy)
to

Next Most Recent Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Next Job

Date From (mm/yyyy) Date To (mm/yyyy) Company Name Position FT/PT Avg. Weekly Earnings
Hours or Miles/wk States / Regions Drove In Equipment Driven If Experienced, Type of Trailer Pulled #Accidents Total Miles
Street City State Zipcode Phone Supervisor
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed
Was this position designated as a "safety-sensitive function" in any DOT-mandated mode subject to the alcohol and drug testing requirement under 49 CFR 382?
Period of Unemployment (mm/yyyy)
to

Additional Message / Information
Copyright 2006 U.S. Logistics Inc., Website Created and Designed by VisionLine Media