Luna | Driver Application

             
            Application for Driver Employment

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, veteran status, non-job related disability, or any other protected group status.

                First Name:
                
                Middle Name:
                
                Last Name:
                
                Email:
                
                Phone:

                Current Address:
                
            Apt/Suite:
                
                City:
                
                State:
                
                Zip:
                
How Long:

Are you lawfully authorized to work in the United States?

Yes No

Date of Birth:

Have you ever been employed here before?

Yes No

Date available to start?

Rate of pay expected?

Are you able to perform the "essential functions" of the driving job for which you are applying?

Yes No Need more information about the jobs "essential functions" to respond

Employment History

Employer/Company Name

Date Employed From:

Date Employed To:

Position(s) Held:

            Contact Person:
            
            Phone Number:
            
                    Were you subject to the FMCSRs while employed?
                
                     Yes  
                     No

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?

Yes No

Reason for leaving:

Accident Record for past 3 years or more (List accidents from most recent to oldest)

DATES	Nature of Accident (Head-on, Rear-end, Upset, etc.)	Fatalities	Injuries	Haz-Mat Spill

Traffic Convictions & Forfeitures for the past 3 years (Other than parking violations)

Location	Date	Charge	Penalty

Experience and Qualifications - Driver (Driver licenses or permits held in the past 3 years)

State	License No.	Class	Endorsement(s)	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

Driving Experience

Class of Equipment	Type of Equipment	Date From	Date To	~Total Miles
Straight Truck Yes No	Van Tank Flat Dump Refer
Tractor & Semi-Trailer Yes No	Van Tank Flat Dump Refer
Tractor - Two Trailers Yes No	Van Tank Flat Dump Refer
Tractor - Three Trailers Yes No	Van Tank Flat Dump Refer
Motorcoach - School Bus (More than 8 passengers) Yes No	------
Motorcoach - School Bus (More than 15 passengers) Yes No	------
Other

Experience and Qualifications - Other

Show any trucking, transportation or other experience that may help in your work with this company:

List courses and training other than stated previously on this application:

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to re-apply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her race, color, religion, sex (including pregnancy), national origin, ancestry, age, disability, veteran status, genetic information, or any other protected status under applicable federal, state, or local law.

NOTE: This Company complies with Indiana law prohibiting smoking in enclosed areas within places of employment.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant

Date

 
AN EQUAL OPPORTUNITY EMPLOYER