Driver Employment Application

MR Paving & Excavating, Inc. 2020 N Spring St, New Ulm, MN 56073
COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED.
Name
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Do you have legal right to work in the United States?
Current Address(Required)
Mailing Address
Previous Address
Previous Address
Previous 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.
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Driving Experience: Straight Truck Experience
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Driving Experience: Tractor & Semi - Trailer
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Driving Experience: Tractor & 2 trailer
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Driving Experience Tractor & Tanker
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Accident Record for the Past 3 Years
If None select NONE
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Traffic Convictions and Forfeitures for the Past 3 Years (other than parking violations)
If None select NONE
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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?

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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.
Name
Address
Phone Number
Position Held
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From
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To
Reason for Leaving
Salary
Explain any gaps in Employment
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Was the job designated 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?
Name
Address
Phone Number
Position Held
MM slash DD slash YYYY
From
MM slash DD slash YYYY
To
Reason for Leaving
Salary
Explain any gaps in Employment
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Was the job designated 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?