Click Here to Apply! — Hoosier Transit

Please make sure you meet all of the following requirements before filling out this form.

● Must be 23 years of age or older
● Must have a CDL class B and have passenger and air brake endorsements
● Must have current DOT physical
● Be able to pass a DOT certified drug test
● No careless/reckless driving or DUI/DWI history in the last 5 years

Company: Hoosier Transit

Address: 505 South Oakland Ave.

City: Nappanee

State: IN

ZIP: 46550

(Answer all questions – please print)

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability

Date of Application

YYYY

Position(s) Applied for

Name

First Name

Last Name

Social Security No.

Drivers License No.

List your addresses of residency for the past 3 years.

Current Address

How long?

Phone

Cell Phone

Previous Address 1

How long?

Previous Address 2

How long?

Previous Address 3

How long?

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

Date of Birth

YYYY

Can you provide proof of age?

(Required for Commercial Drivers)

Have you worked for this company before?

Where?

Dates? From/To

Rate of Pay

Position

Reason for leaving

Are you now employed?

If not, how long since leaving last employment?

Who referred you?

Rate of pay expected

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description)?

If yes, explain if you wish

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.
Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.

Employer Name/Address 1

Contact Person 1

Phone No. 1

Dates Employed 1

Position Held 1

Salary/Wage 1

Reason for Leaving 1

Employer Name/Address 2

Contact Person 2

Phone No. 2

Dates Employed 2

Position Held 2

Salary/Wage 2

Reason for Leaving 2

Employer Name/Address 3

Contact Person 3

Phone No. 3

Dates Employed 3

Position Held 3

Salary/Wage 3

Reason for Leaving 3

Employer Name/Address 4

Contact Person 4

Phone No. 4

Dates Employed 4

Position Held 4

Salary/Wage 4

Reason for Leaving 4

Employer Name/Address 5

Contact Person 5

Phone No. 5

Dates Employed 5

Position Held 5

Salary/Wage 5

Reason for Leaving 5

Employer Name/Address 6

Contact Person 6

Phone No. 6

Dates Employed 6

Position Held 6

Salary/Wage 6

Reason for Leaving 6

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding

Dates Last Accident

Nature of Accident (Head-On, Rear-End, Upset, Etc)

Fatalities

Injuries

Next Previous

Nature of Accident (Head-On, Rear-End, Upset, Etc)

Fatalities

Injuries

Next Previous

Nature of Accident (Head-On, Rear-End, Upset, Etc)

Fatalities

Injuries

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Location

Date

YYYY

Charge

Penalty

Location

Date

YYYY

Charge

Penalty

Location

Date

YYYY

Charge

Penalty

EDUCATION

ENTER HIGHEST GRADE COMPLETED

LAST SCHOOL ATTENDED

Name/City

EXPERIENCE AND QUALIFICATIONS – DRIVER

DRIVER LICENSES

List all licenses

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

Yes

Has any license, permit or privilege ever been suspended or revoked?

Yes

DRIVING EXPERIENCE IF NONE, WRITE NONE CLASS OF EQUIPMENT STRAIGHT TRUCK

CLASS OF EQUIPMENT TRACTOR AND SEMI-TRAILER

CLASS OF EQUIPMENT TRACTOR – TWO TRAILERS

CLASS OF EQUIPMENT MOTORCOACH – SCHOOL BUS

CLASS OF EQUIPMENT OTHER

LIST STATES OPERATED IN FOR LAST FIVE YEARS

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?

SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)

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 authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiri4es regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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 giving in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

TO BE READ AND SIGNED BY APPLICANT