Driver's Application for Employment

Carstensen & Sons Trucking, Inc.

700 Cannon Industrial Blvd
Cannon Falls, MN 55009

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, or non-job related disability.

If you have additional information that will not fit in the blanks below, please save your information into a
Word document or a Notepad document and attach it with the "Attach" feature at the bottom of this page. -Thank You!

Position(s) Applied For:

Personal Information

First Name:

Middle Initial:

Last Name:

Address 1:

Address 2:

City, State, Zip:

How Long?:

Email Address:

Phone Number:

Social Security Number:

Date of Birth:

*required for Commercial Drivers
Can you provide proof of age? Yes No

Available Start Date:

Previous Addresses - { List your address of residency for the past 3 years. }

Address 1:

Address 2:

City, State, Zip:

How Long?:

Address 1:

Address 2:

City, State, Zip:

How Long?:

Address 1:

Address 2:

City, State, Zip:

How Long?:

Employment Details

Have you ever worked for this company before? Yes No

Where:
Dates: (From) (To)

Reason for leaving:

Rate of pay:

Position:

Are you employed now? Yes No

If not, how long since leaving last employment?

Who refered you?

Rate of pay expected:

Is there any reason that you might be unable to perfom the functions of the job for which you have applied? Yes No

* If you answered "Yes" to the above question, explain below if you wish to do so.

Employment and Driving History

~ All driver 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 of information on those employers for whom the applicant operated such vehicles.
-Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to
transport hazardous materials in a quantity requiring placarding. )

Employment History (List employers in reverse order starting with the most recent.)

Employer:

Address:

City, State, Zip:

Phone:

Job Title:

Supervisor Name:

Reason For Leaving:

Start Date:

End Date:

Work Performed:

May We Check References? Yes No

Employer:

Address:

City, State, Zip:

Phone:

Job Title:

Supervisor Name:

Reason For Leaving:

Start Date:

End Date:

Work Performed:

May We Check References? Yes No

Employer:

Address:

City, State, Zip:

Phone:

Job Title:

Supervisor Name:

Reason For Leaving:

Start Date:

End Date:

Work Performed:

May We Check References? Yes No

Employer:

Address:

City, State, Zip:

Phone:

Job Title:

Supervisor Name:

Reason For Leaving:

Start Date:

End Date:

Work Performed:

May We Check References? Yes No

Employer:

Address:

City, State, Zip:

Phone:

Job Title:

Supervisor Name:

Reason For Leaving:

Start Date:

End Date:

Work Performed:

May We Check References? Yes No

Accident Record (List all accidents on your record from the past 3 years - If non, enter 0.)

Please enter the number of traffic convictions you've had over the past 3 years:

(Last Account) - Date:

Nature of Accident:

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

Number of Fatalities:

Number of Injuries:

(Next Previous) - Date:

Nature of Accident:

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

Number of Fatalities:

Number of Injuries:

(Next Previous) - Date:

Nature of Accident:

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

Number of Fatalities:

Number of Injuries:

Traffic Convictions (All traffic convictions or forfeitures from the past 3 years - If none, enter 0.)

Please enter the number of traffic convictions you've had over the past 3 years:

Location:

Date:

Charge:

Penalty:

In a commercial vehicle? Yes No

Location:

Date:

Charge:

Penalty:

In a commercial vehicle? Yes No

Location:

Date:

Charge:

Penalty:

In a commercial vehicle? Yes No

Education & Experience

Degree:

Qualifications

Driver Licenses

State:

License No.:

Type:

Expiration Date:

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

B. Has any license, permit or privilege ever been suspended or revoked? Yes No

If the answer to A or B is YES.....Please explain below:

Driving Experience

Class Of Equipment	Type of Equipment	Dates		Approx. Miles
Class Of Equipment	(van,tank,flat,etc.)	From	To	Approx. Miles
Straight Truck
Tractor & Semi-Trailer
Tractor - Two Trailers
Motor Coach - School Bus
Other

List states operated in for last five years:

Show special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

Experience & Qualifications - Other

Please list any Trucking, Transportation or Other experience that may help in your work for this company.

List 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).

49 CFR 40.25(j)

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administrated by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?

Yes No

If YES - Have you successfully completed the return-to-duty process?

Yes No

If YES - Documentation MUST BE PROVIDED before any safety-sensitive transportaion function is performed.

Attachments (Attach up to 3 documents if necessary)

Attachments should be in Word, PDF, or Plain Text, and not larger than 100K.
Make sure that your full name is in the file name (ex. Work History - John Doe.doc).
Attach documents with:
1. Additional "Previous Employment"
2. Additional "Accident Information"
3. Additional "Traffic Conviction Info"
4. Other (ex. Resume, More Driver Licenses, etc...)

Applicant's Statement

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. 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 made 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 have read and understood the Applicant's Statement.

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 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.

I have read and understood the Fair Credit Reporting Act Disclosure Statement..

Driver's Application for Employment

Carstensen & Sons Trucking, Inc.

Personal Information

Previous Addresses - { List your address of residency for the past 3 years. }

Employment Details

Employment and Driving History

Employment History (List employers in reverse order starting with the most recent.)

Accident Record (List all accidents on your record from the past 3 years - If non, enter 0.)

Traffic Convictions (All traffic convictions or forfeitures from the past 3 years - If none, enter 0.)

Education & Experience

Education

High School

Business, Trade,or Tech School

College,Undergraduate

College,Graduate

Other Education

Qualifications

Driver Licenses

Driving Experience

Experience & Qualifications - Other

49 CFR 40.25(j)

Attachments (Attach up to 3 documents if necessary)

Applicant's Statement

Fair Credit Reporting Act Disclosure Statement

Business, Trade,
or Tech School

College,
Undergraduate

College,
Graduate