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Driver's Application for Employment

F&F TRANSPORT, Inc.

1162 CAYADUTTA STREET
FONDA, NY 12068

We are an equal opportunity employer.

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)
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.
I certify that the information given by me on this application and during the interview process is true and complete in all respects, and I agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the Company's judgment) that I will be disqualified from consideration for employment or subject to immediate dismissal if discovered after I am hired.
I also understand that if I'm hired by the Company, that my employment is at-will and 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 employer(s) 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:

Review information provided by previous employers;
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
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.

Complete Name of Applicant (Signature): Date: I Agree

Each inquiry on this application must be fully answered or completed.

PERSONAL INFORMATION

Date of application:

Position(s) Applied for

Last Name: First Name: Middle:

Social Security #: Phone

List your addresses of residency for the past 3 years.

Current Address:

Street	City	State	Zip	How Long? (yr./mo.)
Street:	City:	State:	Zip:	How Long? (yr./mo.):

Previous Address:

Street	City	State	Zip	How Long? (yr./mo.)
Street:	City:	State:	Zip:	How Long? (yr./mo.):
Street:	City:	State:	Zip:	How Long? (yr./mo.):
Street:	City:	State:	Zip:	How Long? (yr./mo.):

Do you have the legal right to work in the United States? yes no

Date of Birth (Required for Commercial Drivers): Can you provide proof of age? yes no

Have you worked for this company before? yes no Where?

Dates: From To Position

Reason for leaving

Are you employed now? yes no If not, how long since leaving last employment?

Who referred you? Rate of pay expected

Have you ever been bonded? (Answer only if a job requirement) yes no Name of bonding company

Prior to conducting a background investigation, the Company will provide you with a release form that complies with the Fair Credit Reporting Act and any applicable state law.

Have you ever been convicted of a felony? yes no If yes, please explain fully. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered.

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but were not hired, for safety-sensitive transportation work covered by DOT drug and alcohol testing rules in the past two (2) years? yes no If yes, please explain below:

EDUCATION

Choose highest grade completed: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: None 1 2 3 4

Last school attended:
Name: City/State:

EMPLOYMENT HISTORY

All driver applicants to drive 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. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

Do you have employment experience? yes no

Employer	Date
Name:	From Month Year
Address:	To Month Year
City: State: Zip:	Position Held:
Contact person: Phone:	Reason for Leaving:
Were you subject to the FMCSRs+ while employed? yes no
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	Date
Name:	From Month Year
Address:	To Month Year
City: State: Zip:	Position Held:
Contact person: Phone:	Reason for Leaving:
Were you subject to the FMCSRs+ while employed? yes no
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	Date
Name:	From Month Year
Address:	To Month Year
City: State: Zip:	Position Held:
Contact person: Phone:	Reason for Leaving:
Were you subject to the FMCSRs+ while employed? yes no
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	Date
Name:	From Month Year
Address:	To Month Year
City: State: Zip:	Position Held:
Contact person: Phone:	Reason for Leaving:
Were you subject to the FMCSRs+ while employed? yes no
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	Date
Name:	From Month Year
Address:	To Month Year
City: State: Zip:	Position Held:
Contact person: Phone:	Reason for Leaving:
Were you subject to the FMCSRs+ while employed? yes no
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

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
+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) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD

Have you been involved in an accident within the past three years? yes no
Provide information for accidents within the past 3 years or more (attach sheet if more space is needed)

Dates	Nature Of Accident (Head-On, Rear-End, Upset, Etc.)	No. Of Fatalities	No. Of Injuries	Hazardous Material Spill	City/ State
Last Accident
Next Previous
Next Previous

TRAFFIC CONVICTIONS

Have you had any traffic convictions or forfeitures (other than parking violations) within the past three years? yes no
Provide information for traffic convictions and Forfeitures for the past 3 years (other than parking violations)

Location	Date	Charge	Penalty	Type of Motor Vehicle

(Attach sheet if more space is needed)

EXPERIENCE AND QUALIFICATIONS - DRIVER

	State	License No.	Class	Endorsement(s)	Expiration Date
Driver licenses or permits held in the past 3 years

A. Have you been denied or disqualified from obtaining 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 denied insurance to drive a motor vehicle? yes no
If the answer to either A, B or C is YES, attach a statement giving details.

DRIVING EXPERIENCE

Check YES or NO.

Class of Equipment		Type of Equipment	FROM (M/Y)	(Total)
Class of Equipment		Type of Equipment	Dates	Approx. No. Of Miles
Straight Truck	yesno	VANTANKFLATDUMPREFER
Tractor and Semi-Trailer	yesno	VANTANKFLATDUMPREFER
Tractor - Two Trailers	yesno	VANTANKFLATDUMPREFER
Tractor - Three Trailers	yesno	VANTANKFLATDUMPREFER
Motorcoach - School Bus (More Than 8 Passengers)	yesno	--
Motorcoach - School Bus (More Than 15 Passengers)	yesno	--
Other:

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?

EXPERIENCE AND QUALIFICATIONS - OTHER

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)

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.

Complete Name of Applicant Date I Agree

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Email Address:

Attach A Resume (optional)

You must click the Submit Application button above or we will not receive it

Driver's Application for Employment

F&F TRANSPORT, Inc.

1162 CAYADUTTA STREET FONDA, NY 12068

We are an equal opportunity employer.

TO BE READ AND SIGNED BY APPLICANT

Each inquiry on this application must be fully answered or completed.

PERSONAL INFORMATION

EDUCATION

EMPLOYMENT HISTORY

ACCIDENT RECORD

TRAFFIC CONVICTIONS

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVING EXPERIENCE

EXPERIENCE AND QUALIFICATIONS - OTHER

TO BE READ AND SIGNED BY APPLICANT

1162 CAYADUTTA STREET
FONDA, NY 12068