Employment Application

    * denotes a required field

    PERSONAL INFORMATION

    State*

    Previous Addresses - For 3 years preceding this application

    State

    State

    State

    Are you at least 18 years of age?*

    Have you ever filed an application with us before?*

    Have you ever worked for our company in the past?*

    Are you able to perform the essential job functions of the position for which you are applying?*

    If hired, are you able to submit verification of your legal right to work in the United States?*

    DRIVER LICENSE INFORMATION - FMCSA Required Information

    List DRIVER'S LICENSE NUMBER and the following formation. Please include your CURRENT, valid license plus past 3 years including permits.

    State*

    CDL Class*

    State

    CDL Class

    State

    CDL Class

    CDL INFORMATION

    Commercial A or B or C First Obtained on:*

    CMV DRIVING EXPERIENCE

    Please provide the nature and extent of your experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semitrailers, and pole trailers) which you have operated:

    EMPLOYMENT EXPERIENCE

    Begin with your most current employer.
    Non-CDL Holders: List names and addresses of previous employers during the last THREE years.
    CDL Holders: List names and addresses of previous employers during the last TEN years. (This is a DOT requirement.)

    State*

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #2

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #3

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #4

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #5

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #6

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #7

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #8

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #9

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    Employer #10

    State

    CDL Holders Only:

    I was subject to FMCSR rules while employed at this company:

    My job was designated as a safety sensitive subject to 49 CFR Part 40:

    EDUCATION

    High School*

    Did you Graduate?*

    Additional Education

    Did you Graduate?

    Additional Education

    Did you Graduate?

    MOTOR VEHICLE ACCIDENTS

    Have you had any motor vehicle accidents in which you were involved in the past 3 years?*

    Personal Injuries?

    Fatalities?

    Personal Injuries?

    Fatalities?

    Personal Injuries?

    Fatalities?

    TRAFFIC VIOLATIONS

    Have you had any motor vehicle laws or ordinances (other than violations involving parking only) of which you were convicted or forfeited bond or collateral in the past 3 years?*

    In CMV?

    In CMV?

    In CMV?

    In CMV?

    REVOCATIONS AND SUSPENSIONS

    Have you ever had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended?*

    SPECIAL SKILLS AND QUALIFICATIONS

    For ex. List types of heavy equipment, you can operate and # of years of experience (skid loaders, back hoes, front end loaders, asphalt milling machines, etc.)
    Any certificates you may hold ex OSHA 10 or 30, HazMat, Demolition, etc.

     

    PROFESSIONAL REFERENCES

    List names and contact information of three professional references, not related to you. Professional references may include previous co-workers, supervisors, instructors, or other individuals who are familiar with your professional experiences.

    EQUAL EMPLOYMENT OPPORTUNITY

    Your answers to the following four questions are entirely optional.
    This information will not be used as selection criteria. If you'd rather not share this information, feel free to select "Decline to Answer".

    Gender*

    Ethnicity*

    Disability*

    Veteran Status*

    TO BE READ AND SIGNED BY APPLICANT

    Note: Previous employer(s) may be contacted, and information provided may be used to investigate the applicant's background. Per 391.23(i), (due process rights) the employee can request information received as part of the background investigations completed.

    (i)(1)(i) The right to review information provided by previous employers;
    (i)(1)(ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (i)(1)(iii) The right to have a rebuttal statement attached to the alleged erroneous information, If the previous employer and the driver cannot agree on the accuracy of the information. (For a more detailed explanation of the driver's rights please see FMCSR 391.23)

    "This certifies that the application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize Minnesota Roadway Company to make an investigation of any of the facts set forth in this application."

    All offers of employment are conditional upon satisfactory reference checks. Successful completion of a physical exam and drug test is required for certain classifications.

    I am aware that a consumer report (motor vehicle record) will be obtained on me in the course of consideration for employment.

    I hereby authorize, without reservation, any party, state, or agency contacted by Minnesota Roadways Co., to furnish the above-mentioned information. I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.