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170 W. South Thorndale

Bensenville, IL 60106

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Sat - 8AM - 4PM

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Driver Application

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Driver Application

In compliance with Federal and State equal opportunity laws, qualified applications 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.

Please be sure to print clearly and answer all questions:
Position(s) Applied For:*
Date of Application:*
Date Format: MM slash DD slash YYYY
Name:*
First Last
Home Phone Number:
Cell Phone Number:
E-Mail Address:*
Current Address:*
Street Address City State / Province / Region ZIP / Postal Code Country
Do you have the legal right to work in the United States?*
- Yes
- No
Can you provide proof?*
- Yes
- No
Are you over the age of 18?*
- Yes
- No
If not, can you provide proof of age?
- Yes
- No
Have you worked for United Transportation before?*
- Yes
- No
If Yes
Where:
Dates From/To:
Rate of pay:
Position:
Reason for leaving:
Are you currently employed?
- Yes
- No
If not, how long since leaving last employment?
How did you hear about United Transportation?*
Rate of pay expected:*
Are you seeking:*
- Full-time
- Part-time
What day(s) of the week and hours are you available to work?*
Drivers License:
State:*
License Number:*
Expiration Date:*
Date Format: MM slash DD slash YYYY
Current class of Drivers License?*
Do you have a HAZMAT Endorsement?*
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
- Yes
- No
Has any license, permit or privilege ever been suspended or revoked?*
- Yes
- No
Employment History
**List employers in reverse order starting with the most recent**
1. All driver applicants to driver 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.
2. Applicants to drive a commercial vehicle (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), in intrastate or interstate commerce shall also provide an additional 7 years’ information on those employers for who the applicant operated such vehicle.
First Choose a Number of Previous Employers:*
Employer #1:
Phone:
Address
Street Address City State ZIP Code
Position Held:
Dates of Employment:
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving:*
May we contact this employer for a reference:*
- Yes
- No
Were you subject to the FMCSRs while employed?
- Yes
- No
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) weights or has a GVWR of 10,001 lbs or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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
- No
Employer #2:
Phone:
Address
Street Address City State ZIP Code
Position Held:
Dates of Employment:
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving:*
May we contact this employer for a reference:*
- Yes
- No
Were you subject to the FMCSRs while employed?
- Yes
- No
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) weights or has a GVWR of 10,001 lbs or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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
- No
Employer #3:
Phone:
Address
Street Address City State ZIP Code
Position Held:
Dates of Employment:
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving:*
May we contact this employer for a reference:*
- Yes
- No
Were you subject to the FMCSRs while employed?
- Yes
- No
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) weights or has a GVWR of 10,001 lbs or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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
- No
Employer #4:
Phone:
Address
Street Address City State ZIP Code
Position Held:
Dates of Employment:
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving:*
May we contact this employer for a reference:*
- Yes
- No
Were you subject to the FMCSRs while employed?
- Yes
- No
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) weights or has a GVWR of 10,001 lbs or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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
- No
Education
Last school attended:
Name:*
City:*
State:*
Highest Grade Completed:*
High School:
College:
Driving Experience and Qualifications
Class of Equipment
Straight Truck
Type of Equipment
Dates (from - to)
Approx. number of total miles
Tractor and Semi-trailer
Type of Equipment
Dates (from - to)
Approx. number of total miles
Tractor – two trailers
Type of Equipment
Dates (from - to)
Approx. number of total miles
Other
Type of Equipment
Dates (from - to)
Approx. number of total miles
List states operated in for the last five years:*
Show special courses or training that will help you as a driver:
Which safe driving awards do you have and from whom?
Accident Records for Past 5 Years
**List accidents in reverse order starting with the most recent**
Date:
Date Format: MM slash DD slash YYYY
Nature of Accident:
Fatalities
Injuries:
Date:
Date Format: MM slash DD slash YYYY
Nature of Accident:
Fatalities
Injuries:
Date:
Date Format: MM slash DD slash YYYY
Nature of Accident:
Fatalities
Injuries:
Traffic Convictions and Forfeitures for Past 5 Years
**List convictions and forfeitures in reverse order starting with the most recent – do not include parking violations**
Date:
Date Format: MM slash DD slash YYYY
Location:
Charge:
Penalty:
Date:
Date Format: MM slash DD slash YYYY
Location:
Charge:
Penalty:
Other Experience and Qualifications
Show any trucking, transportation, or other experience that may help in your work for this company:
List courses and training other than shown elsewhere on this application that may help in your work for this company:
List special equipment or technical materials you can work with other than those already shown:
Declaration of Employment Status
I understand that I must provide my complete employment history for the past three (3) years, and all CDL required employment for the seven (7) years preceding that. Any gaps in employment longer than one (1) month are explained as follows:
From:
To:
During this time, I was engaged in the following activity:
To Be Read and Signed By Applicant
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. In the event of employment, I understand that false or misleading information given in my applications or interview(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 employers 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:
1. Review information provided by the previous employers;
2. 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
3. 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.
Applicant’s Signature:*
Date:*
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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Contact Information

170 W. South Thorndale Ave.

Bensenville, IL 60106

Office: (630) 422-7076

Fax: (630) 422-7787

dispatch@unitedtransportation.com

intermodal@unitedtransportation.com

Office Hours: 8 AM - 5.30 PM

Warehouse Hours: 8 AM - 7 PM.

After 7PM appointment only.

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