Current Address

Previous Address

Education

Years of formal education completed:

Work History

Currently Employed?

Driving Experience & Information

Number of years’ experience as a professional driver:

License now held, please check all that are applicable:
Are you willing to attend driver training courses? *
Are you willing to do a pre-employment background and drug screen? *
Do you consent to us doing a criminal background check? *
Do you consent to us performing a motor vehicle check? *
Are you willing to display our Company signage in your vehicle? *
Are you willing to allow the Company or any regulatory body agency overseeing this line of work inspect your equipment (to include personal or company vehicles)? *

Driver Qualifications

Are you 24 years of Age or older? *
Have you been driving professionally for more than 3 years, or driving without an at fault incident or less than 3 minor infractions for more than 3 years? *

Driving Record Background

(Applicants will be cleared through obtaining a Motor Vehicle Record)

Have you had a traffic moving violation in the last 3 years? *
Have you had any type of driving accidents in the last 3 years? *
Have your driving privileges ever been suspended, revoked or denied? *
Have you ever had a limousine or taxi driver certificate suspended or revoked by the authority due to a regulatory violation? *
Have you been charged with a DUI, reckless driving, leaving the scene of an accident, driving without a license or insurance or driving with a suspended license? *

Driver Criminal Background

(Applicants will be cleared through obtaining a Criminal Background Report

Have you ever been convicted of any of the following felonies within the last 10 years?

Driving under the influence of drugs and alcohol? *
Felony involving theft? *
Felony involving fraud? *
Felony for a violation of the act of April 14, 1972 (P.L.233, No.64), known as The Controlled Substance, Drug, Device and Cosmetic Act? *

Have you ever been convicted of any of the following within the last 10 years?

Felony in connection with a motor vehicle? *
Burglary or Robbery? *
A sexual offense under 42 Pa.C.S. Section 9799.14(c) or (d) (relating to sexual offenses and tier systems) or similar offense under the laws of another jurisdiction or under a former law of this Commonwealth? *

 (Applicants will be cleared through obtaining a Sam, OIG and Sex Offender Report)

A crime of violence as defined in 18 Pa.C.S. Section 5702(relating to definitions) or a similar offense under the laws of another jurisdiction or under a former law of this Commonwealth? *
An act of Terror? *

References

Do not use relatives. Include at least one business and one professional person. Please provide name, telephone number and occupation.

Emergency Contact

List the name and phone number of an emergency contact we could use to relay information on your behalf.