KPO LOGISTICS DRIVER APPLICATION

1600 W Lake ST, Ste. 103B Addison, IL 60101

An Equal Opportunity Employer

APPLICANT INFORMATION

Name
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Do you have a legal right to work in the United States?

PREVIOUS THREE YEARS RESIDENCY

Residency
Street
City
State
Zip code
# Years at address
 

LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

License information
State
License №
Type/Class
Endorsements
Expiration date
 
Previously held licenses
State
License №
Type/Class
Endorsements
Expiration date
 

ACCIDENT RECORD FOR THE PAST 3 YEARS

Accident record
Class of equipment
Type of equipment (van, tank, etc.)
Date from
Date to
Approx # of miles (total)
 

DRIVING EXPERIENCE

Driving experience
Dates (list more recent first)
Nature of accident (Head-on, rear-end, upset, etc.)
# Fatalities
# Injuries
Chemical spills (Y/N)
 

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

Traffic convictions
Date convicted (Month/Year)
Violation
State of violation
Penalty (Forfeited bond, collateral and/or points)
 
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privilege ever been suspended or revoked?

EMPLOYMENT HISTORY

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Current (most recent) employer

Name
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Was the job designed as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Second (most recent) employer

Name
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Was the job designed as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Third (most recent) employer

Name
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Was the job designed as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Education

Education
School
Name and location
Course of study
Years completed
Graduate
Details
 

Other qualifications

To be read and signed by applicant

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. 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 resend 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.

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. Note: A motor carrier may require an applicant to provide more information that required by the Federal Motor Carrier Safety Regulations.

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