Phone (276) 620-6829

Fax (336) 719-6696

2146 Epworth Road
Cana, VA 24317

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Driver Application

Electronic Signature Verification

Terms of Acceptance and Signature

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.  (Generally, inquiries regarding medical history will be make only if and after a conditional offer of employment has been extended.)  I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e).  I understand that I have the right to:

  • Review information provided by previous employers.

  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Electronic Signature* 

           

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

APPLICATION INSTRUCTIONS

Please read and answer each question carefully and to the best of your ability.  If you do not know the answer, you must input "n/a" or "not applicable" in the blank.  The form is set up so that it cannot be submitted without all questions answered.  Please take your time with this process, you may have to research dates or information for a correct application.  If you have any questions, you may reach Wendy at (336) 648-9531 or vdassales@gmail.com.  Thank you for your interest!

All applications must include the following:

  • Current medical card

  • Copy of CDL license (front and back)

  • Current MVR obtained from your local DMV

Additionally, you will need to print and sign BOTH copies of the REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER sheets.  Click here to download and print. Do not write in employer information, that is handled in-office.

Once your application has been reviewed and approved, you will be called for an interview and drug test.

Venture Drive-Away Service, Inc.

2146 Epworth Road

Cana, VA  24317

In compliance with Federal and State equal 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.

                                                                                                                                Date of Application

                                                                                                                                Social Security Number

List your addresses for the past THREE years.

Current Address

Previous Addresses

 

 

Do you  have a legal right to work in the United State?

Can you provide proof of age?

Have you worked for this company before?                                                     Where?

Dates:                                                                                                           

Are you now employed?

                                                                                    

Have you ever been bonded?                                                                  

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?

 

Employment History

All drivers applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years.  List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. 

(NOTE: List employers in reverse order starting with the most recent.)

*Includes vehicle having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 lbs. or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

EMPLOYER                                                                                                          DATE EMPLOYED

                                                                                                                           

                                                                                                             

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

EMPLOYER                                                                                                          DATE EMPLOYED

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

EMPLOYER                                                                                                          DATE EMPLOYED

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

EMPLOYER                                                                                                          DATE EMPLOYED

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

EMPLOYER                                                                                                          DATE EMPLOYED

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

EMPLOYER                                                                                                          DATE EMPLOYED

Were you subject to FMCSRs while employed?

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

ACCIDENT RECORD 

Have you had an accident in the past 5 years? 

If none, skip to the next section.

Accident Date              Nature of Accident                     Fatalities              Injuries               Fault                 Hazardous Material Spill

                               (head on, rear-end, upset, etc.)

TRAFFIC CONVICTIONS

Have you had any traffic convictions and forfeitures for the past 3 years (other than parking violations).

If none, skip to next section.

EXPERIENCE AND QUALIFICATIONS

Please list driver licenses or permits held in the past 3 years.

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

B. Has any license, permit, or privilege ever been suspended or revoked?

DRIVING EXPERIENCE

Class of Equipment                 Type of Equipment                           From                               To                         Approx. # of miles

                                                                                                   

 

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION

What is your highest level of education completed?

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

APPLICANT SIGNATURE                                                                              DATE

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

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 Reform Act of 1996 (Title II, Subtitle D, Chapter 1, 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, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

APPLICANT SIGNATURE                                                                             DATE

PRINT NAME                                                                                                SOCIAL SECURITY NUMBER

Please upload the following items:

Copy of CDL License                                          Current Medical Card                                        Current MVR

Request for Information From

Previous Employer (2 copies)

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