Semi Truck Driving Careers | Kruepke Trucking

Employment Application

Basic Information

Position Applying For*

Click here to download the general application

First Name*

Last Name*

Middle Name

Birth Date*

Address

Street*

City*

How Long?

State*

Postal Code*

Phone

Address For The Past Three Years

Address 1

Street

City

State

Postal Code

How Long?

Address 2

Street

City

State

Postal Code

How Long?

Employment History

Employer 1

Name

Street

City

State

Postal Code

Phone

From

Position Held

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?

Yes

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?

Yes

*Account for period between jobs - Include dates (month/year) and reason

Employer 2

Name

Address

City

State

Postal Code

Phone

From

Position Held

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?

Yes

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?

Yes

*Account for period between jobs - Include dates (month/year) and reason

Employer 3

Name

Address

City

State

Postal Code

Phone

From

Position Held

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?

Yes

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?

Yes

*Account for period between jobs - Include dates (month/year) and reason

*Any gaps in employment and or/unemployment must be explained
**The Federal Motor Carrier Safety Regulations 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) for compensation; or (3) is designed or used to transport more than 15 passengers, including the driver, and is not used to transport passengers for compensation; or (4) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Experience and Qualifications

Class of Equipment	Type of Equipment (Van, Tank, Flat, etc.)	From	To	Approx. No. of Miles (Total)
Straight Truck	Van Reefer Tank Flat
Tractor & Semi-Trailer	Van Reefer Tank Flat
Tractor - Two Trailers	Van Reefer Tank Flat
Tractor - Three Trailers	Van Reefer Tank Flat
Motorcoach - School Bus (Greater than 8 passengers)	N/A
Motorcoach - School Bus (Greater than 15 passengers)	N/A
Other	Van Reefer Tank Flat N/A

Accident History

Have you had an accident within the last 3 years?

Yes

Date	Nature of Accident (Head on, rear-end, upset, etc.)	Number of Fatalities	Number of Injuries	Hazardous Materials Spill?
				Yes No
				Yes No
				Yes No

Traffic Convictions and Forfeitures

Have you had any traffic violations and/or forfeitures within the last 3 years?

Yes

Date (Month/Year)	Violation (Other than violations involving parking only)	State of Violation	Penalty (Forfeited bond, collateral and/or points)

License Information

License Number

License State

Expiration Date

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

Yes

Please explain.

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

Yes

Please explain.

Have you tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?

Yes

By submitting this form, you are certifying that this application was completed by you, and that all information is true and complete to the best of your knowledge.

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