Fill out this form online or download the printable version by clicking the button to the right
and return it to us.
Employment for the Past Three Years
Upload additional document if you had more than 3 employers in the past three years.
Third Last Employer
Note: Please list the Names, Addresses, Date of Employment, and Reason for Leaving for all employers for which you operated a Commercial Motor Vehicle during the seven (7) years preceding the three (3) years contained above. If none, state “None.” in the box.
Experience & Qualifications - Driver
Drivers Licenses: List all unexpired licenses and endorsements.
Follow this format: State - License Number - Type - Expiration Date
Follow this format: Class of Equipment - Type of Equipment - From - To - Approx. Number of Miles (Total)
Accident Record for Past 3 Years or More
Include all motor vehicle accidents. List Date, Nature of Accident, (Head on, Rear end, Upset, etc.), Number of Fatalities, and Number of Injuries.
Traffic Convictions and Forfeitures of Bond or Collateral in Past Three Years
Other than parking violations. List Location, Date, Charge, and Penalty.
Other Experience and Qualifications
Professional and Character References
Please list at least three. Include name, address, and phone number.
Applicant Acknowledgment of Drug Test Requirement
I understand that as part of my application for employment I must successfully complete a US-DOT drug test as required by 49 CFR Part 655. I understand that a negative test is required before I will be considered for hire. I also understand that if I am hired to fill a safety sensitive position, participation in the Weirton Transit Corporation drug and alcohol testing program is a condition of my employment.
To be read and signed by applicant.
It is agreed and understood that the employer or his agents may investigate the applicants background to ascertain and all information of concern to applicant’s record, whether same is of record or not. I understand that the information in this application will be used, and that prior employers may be contacted, for purposes of investigation as required by Section 391.23 of the Motor Carrier Safety Regulations. This applicant agrees to furnish such additional information and complete such examinations as may be required to complete his employment file.
I do hereby request and authorize the Weirton Transit Corporation, any person or persons, each former employer, or any Firm or Corporation referred to in this application, to give any information or answer all questions asked concerning my ability, work, or moral character in connection with this application, and release from liability or responsibility all persons, Companies, or Corporations requesting or supplying such information. I further agree that any false statements will disqualify me for employment or cause my subsequent dismissal and that acceptance does not bind either party to a specific period or employment.
This certificates that this application completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.