Driver Application/FULL

Full Application

1 Drivers Application For Qualification

2 Employment History

3 Disclosure Of Previous Drug And Alcohol Results

4 Driver Authorization and Release of Information

Spader Freight Services Inc. 1134 E McPherson Hwy Clyde, OH 43410. Phone: (419) 547-1117. DRIVERS APPLICATION FOR QUALIFICATION 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, or non-job related disability.*
- I Understand
Name*
First Last
Phone*
Email*
Check if you have a Class A CDL:
Date of Birth*
Drivers License Number*
State Drivers License Issued In*
*
Street Address City State / Province / Region

List all employers for the last three years and any employment as a commercial vehicle operator for the last ten years. Please do not leave any gaps. If you worked for an Owner Operator please list the Motor Carrier the truck was Leased to.
Present or Last Employer:
Company Name
Address
Street Address City State / Province / Region Country
Supervisor
Dates Employed
From To
Telephone
Rate of Pay
Reason for leaving
Type Equipment
No. Accidents
May we contact your current employer?
- Yes
- No
Previous Employer:
Company Name
Address
Street Address City State / Province / Region Country
Supervisor
Dates Employed
From To
Telephone
Rate of Pay
Reason for leaving
Type Equipment
No. Accidents
Driving Experience:
Straight truck
From To
Miles driven
Tractor and Semi-trailer
From To
Miles driven
Other
From To
Miles driven
Traffic Convictions and Forfeitures for the last five years (other than parking violations)
Date Location Charge Penalty
Accident Record for past five years:
Date Location Charge Penalty
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 A or B is Yes, please give details
List states operated in for the last 5 years
Show special courses or training that will help you as a driver:

In accordance with Federal Administration Regulations (FMCSA 391.23), we are requested to obtain from all previous employers/lessors in the last three years information concerning your past drug and alcohol test results, including test refusals. Please answer the following questions and sign the certification at the bottom.
DISCLOSURE OF PREVIOUS DRUG AND ALCOHOL RESULTS In accordance with Federal Administration Regulations (FMCSA 391.23), we are requested to obtain from all previous employers/lessors in the last three years information concerning your past drug and alcohol test results, including test refusals. Please answer the following questions and sign the certification at the bottom.*
- I Understand
1. Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past three years?
- Yes
- No
2. Have you tested positive for a controlled substance in the past three years?
- Yes
- No
3. Have you had an alcohol test with a breath alcohol concentration of 0.02 or greater BA, in the last three years?
- Yes
- No
4. Have you refused a required test for drugs or alcohol in the last three years?
- Yes
- No
I hereby certify that the above information is true and correct to the best of my knowledge. I understand that if any of my previous employers/lessors provide information that I tested positive to a controlled substance, had a BAC of 0.02 or greater, or refused a drug or alcohol test, I am subject to immediate termination without recourse.*
- I understand
Signature*
To be Read and Signed by Applicant In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying you previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations. It is agreed and understood that this application for qualification in no way obligates the motor carrier to employ the applicant. It is agreed and understood that if qualified, the driver may be on a probationary period during which time he may be disqualified without recourse. I authorize you to make 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 inquires and releasing information in connection with application. In the event of employment, I understand that false or misleading information given in my application or interviews 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 employers will be contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23(d) and (e). I understand that I have the right to:  Review information provided by current/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 employers and I cannot agree on the accuracy of the information. This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.*
- I understand
Signature*

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 an other protected group status.

TO BE READ AND SIGNED BY APPLICANT
I hereby authorize ___________________________________ (previous employer) to release the following information to Spader Freight Services, for the purposes of investigation as required by section 391.23 of the Federal Motor Carrier Safety Regulations. Previous employer is released from any and all liability which may result from furnishing such information. I hereby authorize my previous employer to release all and any information regarding my alcohol and controlled substance testing records to Spader Freight Services Inc., as required under DOT regulations 49 CFR 382.405 and 382.413. I also herby authorize Spader Freight Services, Inc., to obtain my previous (5) years of crash data and previous (3) years of inspection data from the Pre-Employment Screening Program (PSP) Online Service.

I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required.
I understand that I have a right to:
1. Review information provided by previous employers;
2. Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employers;
3. 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 Name*
Last 4 digits of SSN*
Driver Authorization and Release of Information*
I agree
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 an 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. (General 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.
I hereby authorize ___________________________________ (previous employer) to release the following information to Spader Freight Services, for the purposes of investigation as required by section 391.23 of the Federal Motor Carrier Safety Regulations. Previous employer is released from any and all liability which may result from furnishing such information. I hereby authorize my previous employer to release all and any information regarding my alcohol and controlled substance testing records to Spader Freight Services Inc., as required under DOT regulations 49 CFR 382.405 and 382.413. I also herby authorize Spader Freight Services, Inc., to obtain my previous (5) years of crash data and previous (3) years of inspection data from the Pre-Employment Screening Program (PSP) Online Service.
I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required.
I understand that I have a right to:
1) Review information provided by previous employers;
2) Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employers;
3) 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.
Date of Application*
Date Format: MM slash DD slash YYYY
Signature*

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419-547-1117

Spader Freight Services Headquarters – DC1

1134 E McPherson Hwy
PO Box 246
Clyde, OH 43410

Spader Freight Services – DC2

108 Elm Street
Tiffin, OH 44883

Spader Freight Services – DC3

500 Elm Street
Clyde, OH 43410

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Date	Location	Charge	Penalty

Date	Location	Charge	Penalty

Full Application

Present or Last Employer:

Previous Employer:

Driving Experience:

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