Application For employment

The form below is for the application for employment at Three Rivers Trucking as a driver. All applicants must be able to pass a drug test.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Address For Past 3 Years

Date Of Birth

Phone

(###)

###

####

Drivers License Information

Name on Drivers License

Please List the State, Driver's License Number, Class, Endorsements, and Expiration Date

MVR Release

By checking the box below the applicant authorizes Three Rivers Trucking Inc. to obtain a MVR for the applicant to investigate the status of your license, and to check on performance and safety history associated with your license.

I authorize Three Rivers Trucking to Run a MVR check on my driver's license

Previous Employment History

Previous Employment Information

Please List the Name Of Company, the Address, the Phone Number, the Position Held, the Dates in which you employed, and you reason for leaving. List all employer for the last 10 years.

Next Last Employer

Statement of Due Process Rights for Certain Applicants

Checkbox

Driver applicants with United States Department of Transportation regulated employment during the preceding three years are advised that he or she has the following rights regarding the safety performance history investigative history information to this company from previous employers. -The right to review information provided by previous employers (which may be done at any time, including when applying, or as late as 30 days after. -The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to this company. -The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and driver cannot agree on the accuracy of the information.

Check Box to Certify That You Have Read the Above Statement

TO BE READ AND SIGNED BY APPLICANT

Please enter you name and check the box below to confirm the following; This certifies that this application was competed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Driver applicants are duly informed that the information he/she provides with regard to previous employment may be used and prior employers will be contacted for the purpose of investigating the applicant's safety performance history information as required by Sec. 391.21 and Sec. 391.23 of the Federal Motor Carrier Safety Regulations.

Check to the box to confirm the above statement is true,

Yes, I (the applicant) confirm the above entries information proved are true to the best of my knowledge, and I authorize Three Rivers Trucking Inc. to investigate previous employment history for the above stated reasons.

Date of Application Submission

YYYY