Please Submit your Application to Sonlite Express Inc.

86886 571 Ave. Laurel Ne. 68745

c/o John Hansen 

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.

Instructions to Applicant
Please answer all questions. If the answer to any question is "No" or "None" do not leave the item blank, but write "No"  or "None". This is important!

First Name:

Last Name:

MI:

 

 

 

Address:

City:

State:

 

Home Phone:

Emergency Number:

Age:

Date of Birth

SS Number:

 

 

 

Current & Three Years Previous Addresses:

Where:

From:

To:

  Physical Exam Expiration Date:

 

Education and Employment History

Highest Grade Completed

 

Grade School:

College

Post Grad

 

Give a Complete Record of all employment for the past three years, including any unemployment or self-employment, and all commercial driving experience for the past 10 years.

Present or Last Employer

Name:

Address:

City

  State:

Phone:

Position Held:

From Mo/Yr

To Mo/Yr

Reason for Leaving

Present or Last Employer

Name:

Address:

City

  State:

Phone:

 
Position Held:

From Mo/Yr

To Mo/Yr

Reason for Leaving

Present or Last Employer

Name:

Address:

City

  State:

Phone:

Position Held:

 

From Mo/Yr

To Mo/Yr

Reason for Leaving

Present or Last Employer

Name:

Address:

City

  State:

Phone:

Position Held:

From Mo/Yr

To Mo/Yr

Reason for Leaving

  State:

Phone:

Position Held:

From Mo/Yr

To Mo/Yr

Reason for Leaving

Present or Last Employer

Name:

Address:

City

  State:

Phone:

Position Held:

From Mo/Yr

To Mo/Yr

Reason for Leaving

 

Driving Experience:

Class of Equipment

Straight Truck:

From:

To:

 

 

Total Miles

Tractor and Semi-Trailer:

From:

To:

 

 

Total Miles

Tractor two Trailers:

From:

To:

 

 

Total Miles

 

List States Operated in for the last 5 years.

 

List Special courses/training completed (PTD/DDC,Haz Mat,etc).

 

List Any Safe Driving Awards you hold and from whom.

Accident Record for past 3 years?

Date of Accidents

Type
(Head on, etc.)

Location

# of Fatalities

# of People Injured

 

 

 

Do you have more than 3 in the last 3 years?

Traffic Convections and Forfeitures for the last three years. (other than parking violations)

Date

Location

Charge

Penalty

 

 

 

Do you have more than 3 in the last 3 years?

Drivers License ( List each driver's license held in the past three years)

State

License #

Type

Endorsements

Expiration Date

 

 

 

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

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

C. Have you ever been convicted of a felony?

If the answers to A, B, or C is "YES", give details.

 

Personal References

Name

Address

Phone

 

 

 

 

To Be Read and Signed by Applicant

It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty.

I give the motor carrier and it's agents or representatives the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability  for damages the motor carrier and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

It is agreed and understood that if qualified to operate motor carrier equipment, I may be on a probationary period, during which I may be disqualified without recourse.

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.

Applicant's Signature (Typed)

Date