Jit-Ex, LLC Driver Application

3344 Cazassa Rd. Memphis, TN 38116

PERSONAL INFORMATION

EMPLOYMENT HISTORY

Previous Employer Information: *
 *Please fill out in as much detail as possible*
Name:
Address:
City,State, & Zip:
Contact Person:
Phone #:
Position Held:
Salary/Wage:
Reason for leaving:
Dates Employed w/Company:
Was your job subject to DOT alcohol and drug testing as required by 49 CFR Part 40?
Previous Employer Information:
 *Please fill out in as much detail as possible*
Name:
Address:
City,State, & Zip:
Contact Person:
Phone #:
Position Held:
Salary/Wage:
Reason for leaving:
Dates Employed w/Company:
Was your job subject to DOT alcohol and drug testing as required by 49 CFR Part 40?
Previous Employer Information:
 *Please fill out in as much detail as possible*
Name:
Address:
City,State, & Zip:
Contact Person:
Phone #:
Position Held:
Salary/Wage:
Reason for leaving:
Dates Employed w/Company:
Was your job subject to DOT alcohol and drug testing as required by 49 CFR Part 40?
Previous Employer Information:
 *Please fill out in as much detail as possible*
Name:
Address:
City,State, & Zip:
Contact Person:
Phone #:
Position Held:
Salary/Wage:
Reason for leaving:
Dates Employed w/Company:
Was your job subject to DOT alcohol and drug testing as required by 49 CFR Part 40?
Previous Employer Information:
 *Please fill out in as much detail as possible*
Name:
Address:
City,State, & Zip:
Contact Person:
Phone #:
Position Held:
Salary/Wage:
Reason for leaving:
Dates Employed w/Company:
Was your job subject to DOT alcohol and drug testing as required by 49 CFR Part 40?

DRIVING HISTORY

Please fill out the following section ONLY if the position you are applying for requires you to operate a company vehicle.

Accidents
 Accident record for the past three years.
Date:
Nature of Accident: (head on, rear end, etc.)
Fatalities:
Injuries:
Hazardous Materials Spilled (if any):
-
Date:
Accident: (head on, rear end, etc.)
Fatalities:
Injuries:
Hazardous Materials Spilled (if any):
-
Date:
Accident: (head on, rear end, etc.)
Fatalities:
Injuries:
Hazardous Materials Spilled (if any):
Tickets
 Location:Date:Charge/Penalty:
1
2
3
4

Background

In accordance with 49 CFR Part 40.25(j) the employer is required to ask the employee: Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years? *
Have you ever been convicted of a felony: *
Have you ever been denied a license, permit, or privelege to operate a motor vehicle? *
Has any license, permit, or privelge ever been suspended or revoked? *
Have you ever tested positive or refused a test for drugs or alcohol? *
Are you on probation or parole? *
Criminal actions pending in which you are a defendant? *
 If you answered yes to any of the above, please explain in the comments box below.
0/250 characters

 

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I hereby request and authorize JIT-EX, LLC. and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application

 

I have read and agree to the above release and I give permission to obtain consumer reports about me. *