PVT Employment Application

Driver Application Form

*Applicant: please read and accept the following, prior to submitting this application for qualification.*
(A) The information you provide in this application, including but not limited to the information required by 49 CFR 391.21(b)(10)(11) below may be used, and your previous employers(s) will be contacted, for the purpose of investigating your safety performance history as required by 49 CFR 391.23(d)(e) and 49 CFR 40.25 (re: drug and alcohol information). (B) The prospective motor carrier, Pro Vision Transport, Inc., hereby notifies you that you have the following rights regarding the investigative information that will be provided to us pursuant to 49 CFR 391.23(d)(e): (1) The right to review information provide to us by previous employers/motor carriers; (2) The right to have errors in the information provided to us by the previous employer/motor carrier and for that previous employer/motor carrier to re-send the corrected information to Pro Vision Transport, Inc.; (3) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer/motor carrier and you cannot agree to the accuracy of the information. (C) EQUAL OPPORTUNITY EMPLOYER: In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, disability, and in Michigan, height, weight, and marital status. (D) I understand that if I have a protected handicap that effects my ability to perform the position, I may ask Pro Vision Transport, Inc. to attempt to make accommodation as required by law. I must make my request in writing to Pro Vision Transport, Inc. as soon as possible and no later than 182 days after the date I know or reasonably should know that accommodation is needed.

I have read and accept the information above:

Note: All fields below are required. If a portion is not applicable enter "NA"

Personal Information:

Choose:

Name:

Street:

City:

State:

Zipcode:

Date Of Birth:

Social Security Number:

Home Phone Number:

Cell Phone Number:

E-Mail Address:

Drivers License

License Number:

State Issued:

Expiration Date:

Driving Record

Do you have a class A CDL?

Yes No

Total Years of OTR Driving:

Number of tickets in the last 3 years:

Number of accidents in the last 3 years:

Have any licenses, permits, or privileges ever been suspended or revoked?

Yes No

If yes, please explain:

Have you ever been convicted of or are any charges pending for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof?

Yes No

If yes, please explain:

Have you ever been convicted of or are any felony charges pending against you?

Yes No

If yes, please explain:

Last Employer Information

Name:

Phone Number:

Address:

City:

State:

Zip Code:

Position Held:

Date Hired

Date Left

Salary:

Reason for Leaving:

If you were a driver, complete the following:

Equipment:

Division:

2nd to Last Employer Information

Name:

Phone Number:

Address:

City:

State:

Zip Code:

Position Held:

Date Hired:

Date Left:

Salary:

Reason for Leaving:

If you were a driver, complete the following:

Equipment:

Division:

3rd to Last Employer Information

Name:

Phone Number:

Address:

City:

State:

Zip Code:

Position Held:

Date Hired:

Date Left:

Salary:

Reason for Leaving:

If you were a driver, complete the following:

Equipment:

Division: