APPLICATION FOR

rti

4001 Kansas Ave Kansas City, KS 66106 800-963-3363

Date:

Name:   Nick Name: E-Mail:
Phone:   Date of Birth: S.S.N. #  

DOT requires complete address listing for last 3 years

     
Address: City: State: Zip: Years:
Past Address: City: State: Zip: Years:
Past Address: City: State: Zip: Years:
Past Address: City: State: Zip: Years:
Past Address: City: State: Zip: Years:
Past Address: City: State: Zip: Years:
Monthly Household Expense:
1st Emergency Phone #: Name: Relationship to you:
2nd Emergency Phone #: Name: Relationship to you:
Level of Education: High School College: Did You Graduate: Yes/ No
List Other Courses Or Training:
Have You Ever Attended A Truck Driving School? Yes /No Where?
Military Service Dates: Branch: Type Discharge:
How Many Miles Have You Driven During The Last 12 Months:
In What States Have You Held A valid Driver's License?

State: License #
State: License #

In What State Do You Now Hold A Valid Drivers License?
State: License #:
Exp. Date: Has Your License Ever Been Suspended Or Revoked? Yes /No
What Endorsements Do You Have?
Have You Ever Been Bonded? Yes /No Denied? Yes /No
Have You Ever Been Convicted of a Felony? Yes /No
Accident Record For All Vehicles Driven:
Date
Nature Of Accident
( Head-On, Rear-End, Ect.)
Fatalities YES/NO
Injuries YES/NO
Preventable/Non-Preventable
YES/NO
Traffic Convictions And Forfeitures For The Last 3 Years (Moving Violations):
Location
Date
Charges
Penalty

Employment History

All driver applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall provide the following information on ALL employers during the preceding 10 years.

* 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.

Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
Employer:  From:  To: 
City:  State:  Position: 
Phone Number:  Salary / Wage: 
Reason for Leaving:  
Type Of Vehicle Driven: Type Of Trailer Pulled:
Areas Of Country In Which You Ran:
List Three Personal References Not Related To You:
Name: Address:
Name: Address:
Name: Address:
Date Of Last ICC Physical: Physician's Name & Address:
Height: Weight:
Can You Do The Following? YES/NO
Get In And Out Of Truck?
Get In And Out Of Trailer?
Get Under Unit To Perform Duties, Such As Checking Brakes?
Raise Lower Hood Of Conventional Tractor ?
Raise Lower Trailer Dollies When Under Load?
Apply Enough Pressure To Release Fifth Wheel Pin?
Apply Enough Force To Open And Close Trailer Doors?
Repeatedly Lift And Carry Cargo Weighing Up To 70 Lbs.?
Sit Stationary In A Drivers Seat For Long Period Of Time?
Apply Enough Pressure To Trailer Tandem To Release?
Be On Duty Maximum Hours Allowed By D.O.T. Hours?
Are you Willing to take A Drug Test?
Are there Additional Comments or Statements you wish to make about yourself? Your Experience? Your Personal History? Use Space Provided Below.

To Applicant: READ THIS INFORMATION CAREFULLY BEFORE SUBMITTING THIS APPLICATION.

It is agreed and understood that any misrepresentation of information given in this application will be considered as an act of dishonesty and may result in immediate dismissal.It is agreed and understood that Riverside Transport, Inc. may investigate the applicants background to ascertain any and all information of concern to applicants record, weather same is of record or not, and applicant release employers and persons named therin from all liability for any damages on account of this furnishing such information. The applicant agrees to furnish such additional information and complete such examinations as may be required to complete this file. It is agreed and understood that this application in no way obligates Driver Outpost to employ the applicant.


By clicking "Submit Application" below, this certifies that the application was completed by the applicant and that all entries are true and complete to the best of my knowledge and I have read and understand the above.
I herby authorize procurement of consumer report (s)