Apply for Class A CDL Truck Driver (Reefer Div.)

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Class A CDL Truck Driver (Reefer Div.)
ID:WWTR
Department:Transportation
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
How Long at Address (Yr/Mo)?:
* Phone:
* Email:
* Social Security Number:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment
PERSONAL INFORMATION
List your previous addresses of residency for the past 3 years (if different from current).

Street City State Zip Code How Long (YR/Mo)

* Do you have the legal right to work in the United States?
Yes   No
* Date of Birth
* Can you provide proof of age?
Yes   No
* Have you worked for this company before?
Yes   No
If yes, where?
If yes, when (from - to)?
If yes, please provide rate of pay:
If yes, indicate position:
If yes, reason for leaving
* Are you now employed?
Yes   No
If not, how long since leaving last employment?
* Who referred you?
* Rate of pay expected
* Indicate which location you are applying for
* Have you ever been bonded? (Answer only if a job requirement)
Yes   No
Name of bonding company:
* Have you ever been convicted of a felony?
Yes   No
If yes, please explain fully.  Conviction of a crime is not an automatic bar to employment-all circumstances will be considered.
* Is there any reason you might be unable to perform the functions of the job for which you have applied?
Yes   No
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 who the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)


EMPLOYER 1

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 2

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 3

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 4

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 5

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 6

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 7

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 8

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No

EMPLOYER 9

Employer Name & Address Supervisor's Name and Phone If a current supervisor, may we contact?


Yes
No
NA
Job Title Dates Employed Salary / Hourly Rate
From:

To:
Start:

End:
Reason for Leaving Were you subject to the FMCSRs while employed? (*See explanation at bottom of section) Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and Alcohol testing requirements of 49 CFR part 40? (** See explanation at bottom of section)
Yes
No
Yes
No


*Includes vehicles having a GVWR OF26,001 lbs or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring place carding.

**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring place carding.

DRIVING RECORD
Accident Record

Please list your accident record for the past 3 years of more, starting with the most current accident. If you have not had an accident in the past 3 years, please leave this section blank.

Date Type of Accident
(Head-On, Rear-End, Upset, etc.)
Fatalities Injuries Hazardous Materials Spill
Yes   No
Yes   No
Yes   No

Traffic Convictions

Provide information for all traffic citations, convictions, and forfeitures you have received in the last 3 years. If you have not received any citations, convictions, or forfeitures in the past 3 years, please leave this section blank.

Location Date Charge Penalty

Driver Licenses

List all driver licenses or permits that held in the past 3 years.

State License No. Type Expiration Date

* A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Yes   No
* B. Has any license, permit, or privilege ever been suspended or revoked?
Yes   No
If the answer to either A or B is yes, please give details.

Driving Experience

Class of Equipment   Check Type of Equipment Dates (From - To) Approx No. of Miles (Total)
* Straight Truck
Yes
No
* Tractor and Semi-Trailer
Yes
No
* Tractor – Two Trailers
Yes
No
* Tractor – Three Trailers
Yes
No
* Motorcoach - School Bus
Yes
No
More than 8 passengers
* Motorcoach - School Bus
Yes
No
More than 15 passengers

* List of 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 you 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):

EDUCATION
Check highest grade level completed.

* Highest Grade Level
* College
* Name of last school attended:
* City/State:


AUTHORIZATION
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.

* Signature (type name):* Date:
Location
* What location are you applying for?
Driver IQ release
Please read and complete the form.

DOT D/A DISCLOSURE AND AUTHORIZATION

PART I- DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES - 49 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING


In accordance with DOT Regulation 49 CFR Part 391.23 and 49 CFR Part 40, each as applicable, I hereby authorize release of my DOT-regulated drug and alcohol testing records by the DOT-regulated employer (s) listed below to the requesting employer, W.W. Transport, Inc., via Cisive/Driver iQ or another consumer reporting agency (Agency) for the purpose of the Agency transmitting such records to requesting employer. I understand the information/documents released pursuant to this section is limited to the following DOT-regulated testing items, including pre-employment testing results occurring during the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusal to be tested (including adulterated and/or substituted tests); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation.

If any company listed below furnishes information concerning items (i) through (vi) above, I also authorize such company to furnish the following information, if applicable: (i) dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the previous three (3) years; and (ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years.

List all DOT-regulated employers you have applied with and/or worked for in a safety-sensitive function during the previous three (3) years. If necessary, attach additional pages, including the date, your name, social security number and signature.

* Previous DOT-Regulated Employer/City/State/Phone Number   (List each employer on a seperate line)

By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this Part I disclosure and authorization for release; (iii) prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction; (iv) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other lawful purpose; (v) I understand I  may review this document with legal counsel prior to signing; and (vi) facsimile or photographic copies of this authorization are as valid as an original.

I hereby authorize you to release the following information to W.W. Transport Inc., Inc for the purposes of investigation as required by Parts 40, 382 and 391 of the Federal Motor Carrier Safety Regulations.

* Enter Printed Name (Type full name):
* Enter Electronic Signature (Type full name):
* Social Security Number:
* Date:
Employment Verification Authorization

W.W. TRANSPORT INC.

701 E. Mt. Pleasant St.

West Burlington, IA 52655

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, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

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, inquiries 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 given in my application or inter-view(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to:
Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send 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

* Electronic Signature (Type Full Name):
* Date of Authorization (Today's Date):
PSP Release
Please read and complete the form below

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY
ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with (“Prospective Employer”), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).


When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.


When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.


Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.


Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.


The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION



If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:< br>

I authorize (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.


I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.


I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also
appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by
Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of
my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to
obtain the information authorized above.

* Enter Electronic Signature (Type full name):
* Date:
GENERAL CONSENT FOR LIMITED QUERIES OF THE FMCSA CLEARINGHOUSE

GENERAL CONSENT FOR LIMITED QUERIES OF THE FMCSA CLEARINGHOUSE



Upon signing this form, I, for the duration of employment with W.W. Transport Inc. hereby provide consent for W.W. Transport Inc,. to conduct a limited query of the FMCSA Clearinghouse Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.   I consent to ongoing multiple limited queries for the duration of my employment.

I understand that if the limited query conducted by W.W. Transport Inc.  indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to W.W. Transport Inc. without first obtaining additional specific consent from me.  

I further understand that if I refuse consent for W.W. Transport Inc. to conduct a limited query, W.W. Transport Inc.  must prohibit me from driving and all other safety sensitive functions.

* Enter Electronic Signature (Type full name):
* Date:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

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