Driver Application with Schilli Specialized

Schilli Specialized is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

Personal Information

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Name: *	Home Phone: *	Cell :
Present Address Number/Street: *	City/State/Zip *	How long have you been at this address?
Email Address: *	License # *	License ST: *
Date of Birth: *		Social Security # *
License ever been suspended? Yes No	Any Tickets/Citations in the last 5 years? Yes No	Any Accidents/Incidents in the last 5 years? Yes No
Have you ever tested positive or refused a pre-employment or a random drug screen? Yes No	Have you ever been convicted of a felony or misdemeanor? Yes No	Have you ever been discharged? Yes No
Have you ever been convicted of a DUI? Yes No	Can you obtain at least a 2 year DOT physical? Yes No	Are you willing to run to Canada? Yes No

Additional Information

What area of the country do you enjoy driving in?	What area of the country do you NOT enjoy driving in?
Why do you enjoy being a driver?	What benefits are you interested in?

Employment Data *
Most recent employment first

Company Name:		Phone No.
City/State:	Equip Type:	May we contact your current employer? Yes No
Dates of Employment Work From:		Work To:
Reason for Leaving:

Company Name:	Phone No.	City/State:	Equip Type:
Dates of Employment Work From:		Work To:
Reason for Leaving:

Company Name:	Phone No.	City/State:	Equip Type:
Dates of Employment Work From:		Work To:
Reason for Leaving:

Company Name:	Phone No.	City/State:	Equip Type:
Dates of Employment Work From:		Work To:
Reason for Leaving:

Company Name:	Phone No.	City/State:	Equip Type:
Dates of Employment Work From:		Work To:
Reason for Leaving:

Company Name:	Phone No.	City/State:	Equip Type:
Dates of Employment Work From:		Work To:
Reason for Leaving:

This certifies that all entries are true and complete to the best of my knowledge. Any false, misleading or incomplete statements shall be sufficient grounds for immediate termination of employment. I understand that this information may be used to contact prior employers for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. This application in no way obligates Schilli Specialized to offer me employment. By pressing the "I AGREE" button, I agree to the above terms and wish to be considered for employment by Schilli Specialized.

I understand that Schilli Specialized or its agents may investigate my background to ascertain any and all information of concern to my record, whether same is of record or not, and I release all persons, forms and corporations from all liability for any damages on account of furnishing such information. I understand that I must pass a pre-employment drug test. I also understand that, if hired, I will be required to submit to and pass drug and alcohol testing on a periodic, reasonable cause, post-accident, and random basis, and as otherwise may be required or permitted by law or Schilli Specialized policy. I hereby authorize the Company and its Medical Review Officer(s) to release any such drug or alcohol test results to the Company, its attorneys, government and law enforcement agencies and personnel, future prospective employers and any other person or agency having a legitimate interest therein, and I release Schilli Specialized and its medical review officers from any liability on account of the release of such information.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION.

To check on the status of your application or for addtional information, please call 800.246.6305 or email the recruiting department at drivers@schilli.com

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