Apply – Taylor-Made Transportation – Taylor-Made Transportation, Inc.

Personal Information

Position(s) Applying For

First Name

Middle Name

Last Name

Please leave this field empty.

Social Security # (SSN)

Date of Birth

Can you provide proof of age?

Have you ever been bonded?

Name of bonding company

Who referred you?

Rate of pay expected

Have you ever been convicted of a felony?

If yes, please explain fully below. Conviction of a crime is not an automatic bar to employement. All circumstances will be considered.

Is there any reason you might be able to perform the functions of the job for which you have applied for?

Current Address

Street

City

State

Zip Code

Phone Number

Duration (yr./mo)

Past Addresses

Street

City

State & Zip Code

Duration (yr./mo)

Street

City

State & Zip Code

Duration (yr./mo)

Street

City

State & Zip Code

Duration (yr./mo)

Employment With Us

Have you ever worked for this company before?

If so, where?

Date From

Date To

Rate of Pay

Position

Reason for leaving

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers
during the preceding three (3) years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an
additional seven (7) years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

Are you currently employed?

If no, how long since leaving last employment?

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

First Employer

Name

Address

City

State

Zip

Contact Person

Phone Number

Date From

Date To

Salary / Wage

Position Held

Reason for leaving

Were you subject to the FMCSR's while employed?

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?

Second Employer

Name

Address

City

State

Zip

Contact Person

Phone Number

Date From

Date To

Salary / Wage

Position Held

Reason for leaving

Were you subject to the FMCSR's while employed?

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?

Third Employer

Name

Address

City

State

Zip

Contact Person

Phone Number

Date From

Date To

Salary / Wage

Position Held

Reason for leaving

Were you subject to the FMCSR's while employed?

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?

Fourth Employer

Name

Address

City

State

Zip

Contact Person

Phone Number

Date From

Date To

Salary / Wage

Position Held

Reason for leaving

Were you subject to the FMCSR's while employed?

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?

Accident Record

For the past three (3) years or more. If none, just leave those fields blank.

Dates

Nature of Accident

Fatalities

Injuries

Hazardous Material Spill

Dates

Nature of Accident

Fatalities

Injuries

Hazardous Material Spill

Dates

Nature of Accident

Fatalities

Injuries

Hazardous Material Spill

Traffic Convictions

And forfeitures for the past three (3) years (other than parking violations). If none, just leave those fields blank.

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Driver Licenses

List all driver licenses held in the past three (3) years.

State

License No.

Type

Expiration Date

State

License No.

Type

Expiration Date

State

License No.

Type

Expiration Date

A. Have you ever been denied a license, permit, or priviledge to operate a motor vehicle?

B. Has your license, permit, or priviledge every been suspended or revoked?

If the answer to either A or B is yes, please explain.

Driving Experience

Straight Truck

Type of Equipment

Date To

Date From

Approx. No. of Miles

Tractor and Semi-Trailer

Type of Equipment

Date To

Date From

Approx. No. of Miles

Tractor - Two Trailers

Type of Equipment

Date To

Date From

Approx. No. of Miles

Tractor - Three Trailers

Type of Equipment

Date To

Date From

Approx. No. of Miles

Motorcoach - School Bus (more than 8 passengers)

Date To

Date From

Approx. No. of Miles

Motorcoach - School Bus (more than 15 passengers)

Date To

Date From

Approx. No. of Miles

Other

Date To

Date From

Approx. No. of Miles

List states operated in for last five years

Show special courses or training that will help you as a driver.

Which safe driving awards do you hold and from whom?

Other - Experience & 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 in this application

List special equipment or technical materials you can work with (other than those already shown)

Education

Select highest education completed

Name of last school attended

City & State

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.

If you acknowledge the above statement, please write your full name below.