OnlineApplication - Viking Land Transportation

Viking Land Transportation

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and of Viking Land Transportation.

Instructions to Applicant

Today's Date

Please answer all questions. If the answer to any question is "No" or "None", do not leave the item blank, but write "No" or "None".

Nameyour full name

DOBmm/dd/yyyy

*AgeYour Age

Address

City

Zip

Drivers License #

Expire Date

DOT Phy. Ex. Exp. Date

Home Phone

Cell Phone

Your email

Emergency Phone Number

3 Years Previous Address:

Address

From

To

Address

From

To

Address

From

To

Position Applying For:

ContractorDriverContractor's Driver

*The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

Have You Worked for this Company Before?

YesNo

I Worked Here

From

Until

Reason For Leaving

EMPLOYMENT HISTORY

Give a COMPLETE RECORD of ALL employment for the past 10 year, including any unemployment or self employment and all commercial driving experience for the past ten years.

Current or Past Employer

Address

From

To

Position Held

Salary

Phone Number

Reason For Leaving

Were You Subject to the FMCSR* while Employed Here?

YesNo

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 40?

YesNo

Next Past Employer

Past Employer

Address

From

To

Position Held

Salary

Phone Number

Reason For Leaving

Were You Subject to the FMCSR* while Employed Here?

YesNo

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 40?

YesNo

Next Past Employer

Past Employer

Address

From

To

Position Held

Salary

Phone Number

Reason For Leaving

Were You Subject to the FMCSR* while Employed Here?

YesNo

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 40?

YesNo

Next Past Employer

Past Employer

Address

From

To

Position Held

Salary

Phone Number

Reason For Leaving

Were You Subject to the FMCSR* while Employed Here?

YesNo

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 40?

YesNo

Next Past Employer

Past Employer

Address

From

To

Position Held

Salary

Phone Number

Reason For Leaving

Were You Subject to the FMCSR* while Employed Here?

YesNo

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 40?

YesNo

Controlled Substance & Alcohol Testing Information Acknowledgement/Consent Form

As a condition of employment with Viking Land (Motor Carrier), Commercial Motor Vehicle (CMV) Driver Applicants must submit to a pre-employment controlled substances test as required by the Federal Motor Carrier Safety Regulations (FMCSR) Section 3B2.301. A motor carrier must receive verified negative test results for the applicant driver for the applicant to be eligible for employment.

If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing on you under numerous situations including, but not limited to, the following:

Post-Accident - Section 382.303

Random - Section 382.305

Reasonable Suspicion - Section 382.307

Return to Duty - Section 382.309

Follow-up Section 382.311

All controlled substances and alcohol testing will be conducted in accordance with Parts 40 and 382 of the FMCSR.

A driver who tests positive for a controlled substance(s)and/or alcohol test, will be immediately removed from a safety sensitive position as required by Part 382 of the FMCSR. Federal law prohibits a driver from returning to a safety sensitive position for any motor carrier until and unless the driver completes the Substance Abuse Professionals (SAP) evaluation,referral and educational/treatment process, as described in FMCSR Part 40,Subpart 0.

I have read the above controlled substances and alcohol testing requirements and understand them.

Yes

To be Read by the Applicant

TO BE READ AND SIGNED BY THE APPLICANT

It is agreed and understood that any misrepresentation given above shall be considered an act of dishonesty.

It is further agreed and understood that Viking Land may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant release employers and persons named herein from all liability for any damages on account of his furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91 - 508,1 have been told that this investigation may include an Investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

It is agreed and understood that this application for qualification in no way obligates Viking Land to employ the applicant.

It is agreed and understood that if qualified, the driver may be on a probationary period during which time he may be disqualified without recourse.

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 Understand

Yes

PERSONAL REFERENCES

List three Persons for reference, other than relatives, who have knowledge of your safety habits.

Name

Address

Phone Number

Name

Address

Phone Number

Name

Address

Phone Number

DRIVING EXPERIENCE

Straight Truck

To

From

# of Miles

Tractor/Semi Trailer

To

From

# of Miles

Tractor - Two Trailers

To

From

# of Miles

Other

To

From

# of Miles

List States Operated in for the last 5 Years:

0 /

Show Special Courses or Training that will help you as a Driver:

0 /

What Safe Driving Awards do you hold and from whom?

0 /

ACCIDENT RECORD FOR PAST 3 YEARS

Date

Nature of Accident

Fatalities

Injured

Date

Nature of Accident

Fatalities

Injured

Date

Nature of Accident

Fatalities

Injured

Date

Nature of Accident

Fatalities

Injured

TRAFFIC CONVICTIONS & FORFEITURES FOR THE LAST 3 YEARS

(Other than parking violations)

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

DRIVER'S LICENSE (list each driver's license held in the past 10 years)

State

License #

Type

Endorsements

Ex.

State

License #

Type

Endorsements

Ex.

State

License #

Type

Endorsements

Ex.

Have you even been denied a license, permit or privilege to operate a motor vehicle?

YesNo

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

YesNo

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

YesNo

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

YesNo

D.) Have you ever been convicted of a felony?

YesNo

If the answer to A or B is YES, give details

0 /