BWP Transport, Inc.

*Position(s) Applied for:**	Local: OTR: St Clair Midland Fowlerville Plymouth
*Name:**
*Social Security No.:**
*Address:** Street
City
State	Zip
*Home Phone/ Cell:**

Address for past three years

	Street	City	State	Zip	How Long?
1.
2.
3.

Do you have the legal right to work in the United States?* Yes No
Date of Birth *: (MM/DD/YYYY)
Can you provide proof of age?* Yes No
Have you worked for this company before? Where?
Date: From (MM/DD/YYYY)
Date: To (MM/DD/YYYY)
Position:
Reasons For Leaving:
Are you now employed?
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected?
Is there any reason you might be unable to perform the functions of the job for which you have applied? If yes, please explain.*

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle * in intrastate or interstate commerce shall also provide an additional 7 years� of 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.)

Employer 1*

Name:

Address:

City: State Zip

Contact Person:
Phone Number:

From: Mo. Yr.	To: Mo. Yr.
Position Held:
Salary/Wage:
Reasons For Leaving:

Employer 2*

Name:

Address:

City: State Zip

Contact Person:
Phone Number:

From: Mo. Yr.	To: Mo. Yr.
Position Held:
Salary/Wage:
Reasons For Leaving:

Employer 3

Click Here to Add Info

Employer 4

Click Here to Add Info

Employer 5

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Have you had an accident in the past three years?* Yes No

Have you had any Traffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)?* Yes No

Check The Highest Grade Completed*: 1 2 3 4 5 6 7 8 GED High School 1 2 3 4 College 1 2 3 4

Last School Attended:

Name:

City

Experience and Qualifications - Driver

State*	License No.*	Type*	Air Brake*	Exp. Date* (MM/DD/YYYY)
			Yes No

1. Work may require travel to Canada. Do you have a Fast Pass?* Yes No Do you have a Passport?* Yes No Upon employment, a Fast Pass and Passport are required. Are you eligible to aquire them?* Yes No
2. Have You Ever Been Denied a License, Permit or Privilege to Operate a Motor Vehicle?* Yes No
3. Has Any License, Permit or Privilege Ever Been Suspended or Revoked?* Yes No
4. Have you ever been convicted of a felony?* Yes No
If The Answer To Either 2, 3 OR 4 IS YES, Please Give Details
Have you attended a truck driving school? Yes No If Yes, Did You Graduate? Yes No Name Of School: Address: Date Graduated:
Show special courses or training that will help you as a driver:
Which safe driving awards do you hold and from whom:

Experience -- Equipment

Class Of Equipment	Type oF Equipment (van, tank, flat, etc)	Dates (MM/DD/YYYY)	Proxy. No. Of Total Miles
Straight Truck		From: To:
Semi Tractor/Trailer		From: To:
Semi Doubles		From: To:
Other		From: To:

List states operated in for last five years:*
Show any trucking, transportation or other experience that may help in your work for this company*
List any 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)

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.25 of the Federal Motor Carrier Safety Regulations.
If you understand and agree, enter your initials*: