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Driver's Position Application

Thank you for your interest on work withus in MATTA'S LOGISTICS LLC.

You're appling for a TEAM DRIVING POSITION, please complete our online application for employment.

*INCOMPLETE information will delay the processing of your application or prevent it from being submitted

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, marital status, veteran status, non-job related disability, or any other protected group status.

PERSONAL INFORMATION Full Name:

Date of Birth:

Birth Country:

Phone Number:

Email Address:

Social Security Number (last 4 digits):

Emergency Contact Name:

Emergency Contact Phone Number:

Residence Location Address where you live:

City where you live:

State where you live:

Zip Code where you live:

EMPLOYMENT INFORMATION Desired Position:

Years of experience as a truck driver:

How many miles can you run weekly:

When are you able to start:

Are you able to work two weeks out?
Yes No

Are you legally authorized to work in the United States?
Yes No

Are you able to provide proof of eligibility to work in the United States?
Yes No

Do you read, write, and speak English?
Yes No

Have you ever worked for this company before?
Yes No

How did you hear about us?

EXPERIENCE AND QUALIFICATIONS Types of vehicles operated:

Have you ever been involved in an accident while operating a commercial vehicle?
Yes No

List any special skills or qualifications relevant to truck driving:

EMPLOYMENT HISTORY

In-Between Record Company Name:

Employment Dates:
-

Company Address:

Company City:

Company State:

Company Zip Code:

Company Country:

Company Phone:

Position in the company:

Reason for leaving:

Were you terminated/discharged/laid off?
Yes No

May we contact this employer at this time?
Yes No

Did you operate a commercial motor vehicle?
Yes No

Older Record Company Name:

Employment Dates:
-

Company Address:

Company City:

Company State:

Company Zip Code:

Company Country:

Company Phone:

Position in the company:

Reason for leaving:

Were you terminated/discharged/laid off?
Yes No

May we contact this employer at this time?
Yes No

Did you operate a commercial motor vehicle?
Yes No

EDUCATION

Trucking School School Name:

School Phone:

Start and End Date:

School Country:
USA Other

Licenses License Number:

Licensing Authority:

Country in which the license was granted:

Type of license:

License Expiration Date:

DOT Medical Card Expiration Date:

FEDERAL MOTOR CARRIER SAFETY REGULATIONS Under [FMCSR 391.15], are you currently disqualified from driving a commercial motor vehicle? [49 CFR 391.15]
Yes No

Has your license, permit, or privilege to drive ever been suspended or revoked for any reason? [49 CFR 391.21(b)(9)]
Yes No

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? [49CFR 391.21(b)(9)]
Yes No

Within the past two years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test by an employer to whom you applied, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules? [49 CFR 40.25(j)]
Yes No

In the past three (3) years, have you ever been convicted of any of the following offenses? [49 CFR 391.15]

Driving a commercial motor vehicle with a blood alcohol concentration (BAC) of .04 percent or more?
Yes No

Driving under the influence of alcohol, as prescribed by state law?
Yes No

Refusal to undergo drug and alcohol testing as by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations?
Yes No

Driving a commercial motor vehicle under the influence of any drug identified in [21 CFR 1308.11] or any other substance such as amphetamine, a narcotic, or any other habit forming drug ?
Yes No

Transportation, possession, or unlawful use of any [21 C.F.R. 1308.11] (Identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier) ?
Yes No

Leaving the scene of an accident while operating a commercial motor vehicle?
Yes No

Or any other felony involving the use of a commercial motor vehicle?
Yes No

VEHICLE ACCIDENT RECORD

TRAFFIC CONVICTIONS \ VIOLATIONS Have you had any moving violations or traffic convictions in the past 3 years?
Yes No

CRIMINAL RECORD Have you ever been convicted of a crime?
Yes No

Do you have any deferred prosecutions?
Yes No

Do you have criminal charges pending?
Yes No

Have you ever pled "guilty" to, been convicted of, or pled "no contest" to a felony?
Yes No

If you have any felony convictions, do you currently hold a minister's permit to enter or exit Canada?
Yes No

Have you, within the last five years, pled "guilty" to, been convicted of, had prosecution deferred in connection with, or pled "no contest" to a misdemeanor?
Yes No

PSP Disclosure and Authorization By checking the box, I (a) acknowledge that I have read and understand the PSP Disclosure and Authorization and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

FCRA Disclosure By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

FCRA Authorization By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

Clearinghouse Release By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.