Employment Application

Driver Experience   & Qualification: Name:   (First, Middle, Last) Social Security Number:   (xxx-xx-xxxx) Email Address:   Phone Number:   Home    Cell (The US Dept. of Transportation requires that all driver applicants state their date of birth (section 391.21)(p)(2)) Date of Birth:   (Month / Day / Year) Current Address:   Street - City - State - Zip Code Previous Address for Past Three Years:   Street - City - State - Zip Code Previous Address for Past Three Years:   Street - City - State - Zip Code       Accident   Review: Have you had any accidents in the past 7 years?   Yes No If previous answer was 'yes', please list the number of accidents.         Please give the details of any accident in the last three years:     Dates Nature of Accident (Head-On, Rear-End, Upset, etc, Fatalities / Injuries) Last Accident:   Next Previous:   Next Previous:         Traffic Convictions   and Forfeitures: (for the past 3 years other than parking violations)   Location   Date Charge Penalty             License   Data:     EXP. DATE STATE LICENSE # TYPE Driver License Held:         Has your license ever been suspended in the last 7 years?   Yes No Has your license ever been revoked in the last 7 years?   Yes No If either of the two questions above was answered yes please explain:   Have you ever tested positive for alcohol or drugs?   Yes No Have you ever been convicted of a felony?   Yes No Have you ever worked for or applied at H&W Trucking & Logistics ?   Yes No       Date original Class A CDL issued:     (Month / Day / Year) Driver Experience   & Qualification: Are you a graduate of a driving School?:   Yes No If yes, what was your year of graduation:   School Name and Address:         Employment   Record: (The US Dept. of Transportation requires that driver applicants show all employment for the past ten years). Don't leave any gaps - show any period of unemployment. *Start with last or current position, including military experience and work background. Employment   History: (Starting with most   recent or current job)       1. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         2. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         3. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         4. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         5. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         6. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         7. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         8. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         9. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:         10. Employer:   Phone:   Address:   From:     To: Job Position:   Type Equipment Operated:   States Operated In:   Reason For Leaving:

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