Driver’s Application for Employment · If the answer to questions A through F is yes, explain:...

GO Alpine Driver Application DriverApplication.doc Rev 1/2/2014

P.O. Box 775066

Steamboat Springs, CO 80477 Phone: (970) 879-2800Fax: (970) 879-0979

Driver’s Application for Employment

DRIVER APPLICANT ONLY 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.

Signature _________________________________________________ Date ________________________

Applicant Information: Name: _____________________________________________________ Phone #_____________________ (First) (Middle) (Maiden, if any) (Last) Address: _______________________________________________________________________________ (Street) (City) (State) (Zip) (How Long?) Are you over the age of 23? __________________ Email Address: _________________________________

Previous addresses: (If at the above address for less than three years)

Address: _______________________________________________________________________________ (Street) (City) (State) (Zip) (How Long?) Address: _______________________________________________________________________________ (Street) (City) (State) (Zip) (How Long?)

(Attach additional sheet if necessary to account for all addresses in the last 3 years) Are you interested in: Part Time_____ Full Time_____ # of shifts per week_____ Days_____ Nights_____ Have you worked for Go Alpine or Alpine Taxi before? No____ Yes____ If yes, when? ____________________________ How did you hear of Go Alpine? _____________________________ If referral, who? ___________________________________

This position requires the handling of luggage that could weigh up to 100 lbs. Do you have any limitations that would prevent

you from performing this function of the job? No_____ Yes_____ Experience and Qualifications-Driver (Past 10 years)

Drivers Licenses

State License No. Class (type) and endorsements Expiration Date

Current DOT Physical Card? Yes: No: DOT Physical Card Expiration: Driving Experience

Accident record for past three years (attach additional sheet if necessary)

Class of equipment: Type of equipment (Van, Tank, Flatbed, etc.)

Dates (From) (To)

Approximate # of Miles (total)

Straight truck

Tractor and semitrailer

Tractor-Two trailers

Other


Traffic convictions (other than parking violations) and forfeitures for the past three years

(Attach additional sheet if more space is needed)

Location Date Charge Penalty

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, revoked or denied? Yes_____ No_____ C. In the past 2

years, have you ever refused a DOT regulated alcohol or drug test? Yes_____ No_____

D. In the past 2 years have you ever tested positive on a pre-employment or DOT regulated alcohol or drug test? Yes_____ No_____

E. Have you ever been convicted of a felony or violent crime? Yes_____ No_____

F. Have you ever been convicted of a drug or alcohol related traffic incident in the past 7 years? Yes_____ No_____

If the answer to questions A through F is yes, explain: (attach additional sheet if necessary)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Employment Record (attach additional sheet(s) if more space is needed) You are required to give all employment information for at least three years.

If you are applying for a position that requires a CDL you will need to list all employment

where you operated vehicles requiring a CDL for the past ten years. Last employer: Name_____________________________________________ Phone #_________________________________

Address___________________________________________________________________________________

Position held_____________________ Supervisor______________ Dates: ____________________________________ (from) (to) Salary___________________ Reasons for leaving___________________________________________

Was this employer subject to Federal (or PUC) Motor Carrier Safety Regulations? Yes_____ No_____

Were you subject to controlled substance & alcohol testing under 49 CFR

Parts 40/382 while employed here? Yes_____ No_____

Last employer: Name_____________________________________________ Phone #_________________________________

Address___________________________________________________________________________________

Position held_____________________ Supervisor______________ Dates: ____________________________________ (from) (to)

Salary___________________ Reasons for leaving___________________________________________


Were you subject to controlled substance & alcohol testing under 49 CFR Parts 40/382 while employed here? Yes_____ No_____

Dates Nature of accident Fatalities Injuries DOT Recordable

Last accident

Next previous

Next previous



Address___________________________________________________________________________________







Address___________________________________________________________________________________







Address___________________________________________________________________________________







Address___________________________________________________________________________________






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.

(Date)____________________ (Applicant’s signature)___________________________________________________

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal

Motor Carrier Safety Regulations.


Please keep your answers brief, but we do want to know more about you. Thank you.

1. Tell us about yourself. Give a brief description about things you’ve done and jobs you’ve held that relate to this

position:

_________________________________________________________________

_________________________________________________________________

________________________________________________________

2. Why should you be hired for this job?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

3. Why did you leave (or want to leave) your last job?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

4. What do you know about GO Alpine and why do you want to work here?

_________________________________________________________________

_________________________________________________________________

________________________________________________________ 5. What experience do you bring to this position?

______________________________________________________________________________________________

______________________________________________________________________________________________

________________________________________________________

6. Why do you think you would do well at this job?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

7. Are you a team player?

_______________________ ___________________________________________________________________

_________________________________________________________________

___________________________________________________________

8. What is your personal philosophy towards work?

_________________________________________________________________

___________________________________________________________

______________________________________________________________


9. Have you ever been asked to resign or been fired? If yes, why?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

10. What irritates you about co-workers?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

11. What kind of person would you refuse to work with?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

12. Tell me about a problem you had with a past supervisor.

_________________________________________________________________

_________________________________________________________________

________________________________________________________

13. Have you applied for other jobs?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

14. Explain how you would be an asset to this organization.

_________________________________________________________________

_________________________________________________________________

________________________________________________________

15. What is your greatest strength?

_________________________________________________________________

_________________________________________________________________

________________________________________________________

16. Tell me about your ability to work under pressure.

_________________________________________________________________

______________________________________________________________________________________________

_________________________________________________________________________________


FMCSA 391.25 Annual inquiry and review of driving record.

(a) Each motor carrier shall, at least once every 12 months, make an inquiry to obtain the motor vehicle record of each

driver it employs, covering at least the preceding 12 months, to the appropriate agency of the State.

(b) Each motor carrier shall, at least once every 12 months, review the motor vehicle record of each driver it employs to

determine whether that driver meets minimum requirements for safe driving.

(c) Recordkeeping (1) A copy of the motor vehicle record required by paragraph (a) of this section shall be maintained in

the driver’s qualification file. (2) A note, including the name of the person who performed the review of the driving

record required by paragraph (b) of this section and the date of such review, shall be maintained in the driver’s

qualification file.

PERMISSION FOR RELEASE OF INDIVIDUAL RECORDS

I (please print) ________________________________________hereby authorize the release of personal information as

contained in records maintained by the Colorado Department of Revenue, Division of Motor Vehicles, to the requestor

identified below pursuant to the Driver’s Privacy Protection Act (18 USC 2721) and Colorado Law.

Driver’s Social Security Number__________________________

Driver’s Date of Birth__________________________________

Driver’s License Number_______________________________

Driver Signature______________________________________ Date___________________________

Release records to: Troy Anderton, Driver Manager, GO Alpine, PO Box 775066, Steamboat Springs, CO, 80477. Under

penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited by law. I

understand that motor vehicle or driver records that are obtained, resold, or transferred for purposes prohibited by law may

subject me to civil penalties under federal and state law.

I have hereby reviewed the driving record of the above named Driver in accordance with 391.25 and find that he/she:

____Meets the requirement for safe driving

____Does not adequately meet satisfactory safe driving performance

____Is disqualified to drive a motor vehicle pursuant to Section 391.15

Signature of Requestor________________________________________ Date_____________________

07/18/2014

Betty Rubin, HR ManagerManager at

Manager at Go Alpine, PO Box 775066, Steamboat Springs, CO, 80477. Under penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any way prohibited by law. I understand that motor vehicle or driver records that are obtained, resold, or transferred for purposes prohibited by law may subject me to civil penalties under federal and state law.

Driver’s Application for Employment · If the answer to questions A through F is yes, explain:...

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