Online Employment Application | The McGregor Company

APPLICANT INFORMATION

First Name *

Middle Name *

Last Name *

Phone *

Email Address *

Date of Birth *

Social Security Number *

Position Applied For *

Date Available for Work *

Do you have legal right to work in the United States? *YesNo

PREVIOUS RESIDENCY

Total residency

Residency requirements met

Please provide a current and mailing address, as well as any previous addresses you lived at in the last 3 years.

Residence Type *

# of Years at Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP Code *

LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years.

State *

License # *

Type/Class *

Expiration Date *

Endorsements

Do you have any previous licenses to enter? *YesNo

Previously Held Licenses

State *

License # *

Type/Class *

Expiration Date *

Endorsements

DRIVING EXPERIENCE

Straight Truck

Type of Equipment

Date From

Date To

Approx. # of Miles (Total)

Tractor & Semi-Trailer

Type of Equipment

Date From

Date To

Approx. # of Miles (Total)

Tractor & 2 Trailers

Type of Equipment

Date From

Date To

Approx. # of Miles (Total)

Tractor & Tanker

Type of Equipment

Date From

Date To

Approx. # of Miles (Total)

Other

Type of Equipment

Date From

Date To

Approx. # of Miles (Total)

ACCIDENT RECORD

for the past 3 years

Check this box if none

List most recent first

Date *

Nature of Accident *

# Fatalities *

# Injuries *

Chemical Spills *

TRAFFIC CONVICTIONS & FORFEITURES

for the past 3 years (excluding parking violations)

Check this box if none

List most recent first

Date Convicted *

State of Violation *

Violation *

Penalty *

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

Explain *

Has a license, permit, or privilege ever been suspended or revoked? *YesNo

Explain *

EMPLOYMENT HISTORY

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Employers (most recent first)

Name *

Phone *

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Position Held *

From *

Month/Year is sufficient

To *

Month/Year is sufficient

Reason for Leaving *

Salary *

Explain any gaps in employment (include month/year and reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations? *YesNo

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40? *YesNo

EDUCATION

High School

Name & Location *

Years Completed *

Course of Study

Graduate *

Details

College

Name & Location

Years Completed

Course of Study

Graduate

Details

Add more education details

Other

Name & Location *

Years Completed *

Course of Study *

Graduate *

Details

OTHER QUALIFICATIONS

Please list any other qualifications that you have and which you believe should be considered.

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company. I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:

Review information provided by current/previous employers;
Have errors in the information corrected by previous employers, and for those previous employers to resend 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.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Applicant Signature *

Applicant Signature (Printed) *

Date *

Upload a cover letter and references list (optional but recommended)

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