DMT Services, Inc. - Driver Employment Application

D.M.T. Services, Inc.

Application for Employment (Driver)

Please Note:

If you have a resume you would like to send instead of filling this out, then please email to hr@dmtservicesinc.com

This application form was designed for use by persons applying for commercial driving positions. Please answer the questions to the best of your ability. All information will be treated confidentially.

ALCOHOL & DRUG TESTING REQUIRED.

*** Applicants Must Live Within A 60 Mile Radius Of Siloam Springs, AR or Ft. Smith, AR ***

Personal Information

First Name: Last Name:

Federal D.O.T. regulations require you to list all residences held for the previous three years.

Address Line 1: Address Line 2: City: State: Zip: Home Phone: Business Phone: Use this space for additional addresses:

How were you referred to us?

Newspaper Ad School On My Own Current Employee Agency Other

Name of referral source:

Type of Work Desired

Indicate the position for which you are applying:

Do you wish to work:

Full Time Part Time Temporary

Minimum weekly salary requirement: Mileage Requirement: Date available for work: Do you have any commitments to another employer that might affect your employment with us?

Educational Data

School	Print Name, Number, Street, City, State and Zip Code	Years Completed	Degree, Major, or Course
High School
College

Military Experience

Were you in the U.S. Armed Forces? Yes No

If yes, what branch?

From:

To:

Rank at Separation:

Briefly describe your duties:

Employment History (Past 10 Years for Commercial Drivers)

List present or most recent employer first.

May we contact these employers? Yes No

Employer Name 1:

Start Date (Mo/Yr):

End Date (Mo/Yr):

Supervisor's Name & Phone: Reason For Leaving: Employer Name 2:

Start Date (Mo/Yr):

End Date (Mo/Yr):

Reason For Leaving: Additional employment history space (if needed):

Driver Experience & Qualifications

Date of Birth:

Driver's Licenses Held (Past 3 Years)	State	License No.	Type	Exp. Date
License 1
License 2

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

C. Have you ever been disqualified subject to section 391 of the FMCSR? Yes No

If yes to A, B, or C, please give details:

Accident Review & Traffic Convictions (Past 3 Years)

Last Accident Details / Date: Traffic Convictions (Other than parking): Date of last DOT Physical Examination:

I hereby authorize release of any driving record to D.M.T. Services, Inc. for new hire employment purposes.

General Information & References

Are you a U.S. Citizen? Yes No

Are you willing to undergo a pre-employment physical exam and drug screening? Yes No

Have you ever been convicted of a criminal offense? Yes No

Emergency Contact Name & Phone:

Authorization & Submission

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.

Applicant's Name:

Date:

Email:

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