Employment Application for Chauffeur Positions

Chauffeur Position Applying For:*
---Motor Coach ChauffeurCDL ChauffeurNon-CDL Sedan or Limousine ChauffeurAny Position

Name:*

Address:*
City:*
State:*
Zipcode:*

Birthday:*
Social Security Number:*

Primary Phone:*
Secondary Phone:

Email:*

How did you hear about us?:*
---InternetFriendTeam MemberOther If Team Member, enter name:

ADDRESSES FOR LAST 3 YEARS

(If different from above.)

Address 1:
City:
State:
Zipcode:
How long at this address?:

Address 2:
City:
State:
Zipcode:
How long at this address?:

Address 3:
City:
State:
Zipcode:
How long at this address?:

EXPERIENCE & QUALIFICATIONS

LICENSES

State 1: *
License Number:*
Type:*
Expiration Date:*

State 2:
License Number:
Type:
Expiration Date:

State 3:
License Number:
Type:
Expiration Date:

State 4:
License Number:
Type:
Expiration Date:

A) Have you ever been denied a license, permit, or privilege to operate a motor vehicle?:*---YesNo

B) Has any license, permit, or privilege ever been suspended or revoked?:*---YesNo

If the answer to either A or B is YES, please give details below:

DRIVING EXPERIENCE*    At least one Class Of Equipment line must be completed.

Class of Equipment

Straight Truck Type of Equipment
(Van, Tank, Flat, Etc.)
Start Date
(mm-dd-yyyy)
End Date
(mm-dd-yyyy)
Approximate Number
Of Miles (Total)

Class of Equipment

Tractor and Semi-Trailer Type of Equipment
(Van, Tank, Flat, Etc.)
Start Date
(mm-dd-yyyy)
End Date
(mm-dd-yyyy)
Approximate Number
Of Miles (Total)

Class of Equipment

Limos or Buses Type of Equipment
(Van, Tank, Flat, Etc.)
Start Date
(mm-dd-yyyy)
End Date
(mm-dd-yyyy)
Approximate Number
Of Miles (Total)

Class of Equipment

Other Type of Equipment
(Van, Tank, Flat, Etc.)
Start Date
(mm-dd-yyyy)
End Date
(mm-dd-yyyy)
Approximate Number
Of Miles (Total)

ACCIDENT RECORD FOR PAST 10 YEARS    (Enter N/A if not applicable.)

Date 1:*
(mm-dd-yyyy)
Nature of Accident:*
(Rear-end, Upset, Etc.)
Fatalities :*

---YesNoNot Applicable Injuries :*

---YesNoNot Applicable

Date 2:
(mm-dd-yyyy)
Nature of Accident:
(Rear-end, Upset, Etc.)
Fatalities :

---YesNoNot Applicable Injuries :

---YesNoNot Applicable

Date 3:
(mm-dd-yyyy)
Nature of Accident:
(Rear-end, Upset, Etc.)
Fatalities :

---YesNoNot Applicable Injuries :

---YesNoNot Applicable

Date 4:
(mm-dd-yyyy)
Nature of Accident:
(Rear-end, Upset, Etc.)
Fatalities :

---YesNoNot Applicable Injuries :

---YesNoNot Applicable

If any injuries or fatalities, please explain in detail:

TRAFFIC CONVICTIONS FOR PAST 10 YEARS (OTHER THAN PARKING VIOLATIONS)    (Enter N/A if not applicable.)

Date 1:*
(mm-dd-yyyy)
Location:*
(City, State)
Charge :*

Penalty :*

Date 2:
(mm-dd-yyyy)
Location:
(City, State)
Charge :

Penalty :

Date 3:
(mm-dd-yyyy)
Location:
(City, State)
Charge :

Penalty :

Date 4:
(mm-dd-yyyy)
Location:
(City, State)
Charge :

Penalty :

EMPLOYMENT RECORD

Note: Show ALL employment for the past ten (10) years. Include military service if applicable.

Last or Current Employer* (ALL fields MUST be completed.)

Employer Name:*

Address:*
City:*
State:*
Zipcode:*

Position Held:*
From:*
To:*
Salary:*

Reason(s) for leaving:

Subject to drug/alcohol testing requirements per 49 CFR Part 40?:*---YesNo

Second Last Employer

Employer Name:

Address:
City:
State:
Zipcode:

Position Held:
From:
To:
Salary:

Reason(s) for leaving:

Subject to drug/alcohol testing requirements per 49 CFR Part 40?:---YesNo

Third Last Employer

Employer Name:

Address:
City:
State:
Zipcode:

Position Held:
From:
To:
Salary:

Reason(s) for leaving:

Subject to drug/alcohol testing requirements per 49 CFR Part 40?:---YesNo

Has a former employer ever disciplined you for tardiness or absenteeism?*:---YesNo

If YES, please explain:

To the best of your knowledge would you be able to perform all the essential functions of this position with or without reasonable accommodation?*---YesNo

If NO, which functions?

As a prospective employer, we must ask any applicant for a driving position with our company whether he/she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applicant applied for, but did not obtain, during the past three years.

Have you tested positive for drugs/alcohol, or refused to take a pre-employment drug/alcohol test in the three years preceding the date of this application.*:---YesNo

DOT regulations prohibit our utilizing you to perform a “safety-sensitive function” (driving a commercial motor vehicle) if you had a positive test, or a refusal to test, until and unless you provide documents showing successful completion of the return-to-duty process in accordance with DOT regulations.

Per Sec. 391.23(i)(1), you have the following rights regarding the investigative information obtained from previous employers:
i. The right to review information provided by previous employers;
ii. The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer;
iii. The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

ACKNOWLEDGEMENT OF UNDERSTANDING AND CONSENT

To be read and signed by Applicant

It is understood that this application is not an obligation of employment.

I hereby authorize A Touch of Class Limousine to investigate all references and former employment, and I release from liability those supplying such information. Upon offer of employment, I agree to take a drug test at A Touch of Class Limousine request and expense and realize that continued employment may be conditioned upon the findings.

I will provide proof of my eligibility to work as required by “The Immigration Reform and Control Act of 1986”.

I understand that A Touch of Class Limousine can make no guarantee as to the number of hours that I may be assigned from week to week, and any reduction in hours can affect my compensation and benefits. I also understand that I may be required to change days off and scheduled hours on a temporary or regular basis in order to continue my employment. Also, I understand that A Touch of Class Limousine reserves the right to transfer me, as business necessitates, and my continued employment may be predicated upon my acceptance of said transfer. I understand that evenings or weekends may be part of any schedule I may be assigned.

I understand that my employment is not governed by any written or oral contract and is considered an “at will” arrangement. I understand that I am free, as is A Touch of Class Limousine, to terminate employment at any time for any reason, so long as there is no violation of applicable Federal or State law.

I state that the information on this application is true and complete. False statements, misrepresentations, or omission may be cause for cancellation of an employment offer or termination if already employed. I agree that I have read and understand the above acknowledgments and agreements and recognize all of the above as conditions of employment.

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. I am aware of the requirements of the position.

Today's Date: *

Applicant Signature: __________________________________________________________________
(To be physically signed at time of interview. Submission of this application form will be considered an electronic signature.)

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

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Please review ALL information entered BEFORE you submit this form. Error messages will appear in red for incomplete or incorrect entries. The form will not submit with errors.

NO CHANGES can be made after submission. A copy of your completed application will be emailed to the address you provided above.