Page 1 of 6

CDL Driver Application

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.

Answer all questions, do not leave any question blank.


Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.


Please type your FIRST name.

Please type your MIDDLE name.

Please type your Last name.

Invalid email address.

Please List a Valid Contact Number

Current CDL Class
Invalid Input

Invalid Input


List addresses for 3 previous years starting with your current address.

Current
Please List Your Address

Please List Your City

Please List Your State

Please List Your Zip

Invalid Input

Invalid Input


Previous
Please List Your Previous Address

Please List Your Previous City

Please List Your Previous State

Please List Your Previous Zip

Invalid Input

Invalid Input


Previous
Please List Your Previous Address

Please List Your Previous City

Please List Your Previous State

Please List Your Previous Zip

Invalid Input

Invalid Input

Add another address?

Did you have another address?


Previous
Please List Your Previous Address

Please List Your Previous City

Please List Your Previous State

Please List Your Previous Zip

Invalid Input

Invalid Input

 

How did you hear about us?

Please List Who Referred You

Have you applied for work or worked at our Company before?

Have you applied for work or worked at our Company before?

Please detail approx. Dates, Position, and Reason for leaving.

Are you employed now?

Are you employed now?

Invalid Input

Please List Your Desired Salary

Education

Select the highest grade completed:

Invalid Input
 

Work History

Give complete record of all employment for the past 3 years and any commercial driving going back for the past 10 years. Include any unemployment or self-employment periods.

Please List Your Latest Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Latest Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?
Add another job?

Did you have another job?


Please List Your Employer.

Please List Their Contact Phone Number.

Please List Their Address.

Dates Employed

Invalid Input

Invalid Input

Invalid Input

Please List Your Job Title/Position.

Please List Your Supervisor.

Please detail Reason for leaving.

Were you subject to the FMCSRs* while employed here?

Were you subject to the FMCSRs* while employed here?

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?

Did this job require drug & alcohol testing?

*The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designed or used to transport nine or more passengers, or (3) is of any size, used to transport hazardous materials in a quantity requiring placarding.

 

Driving Experience

Class of Equipment Experience.

Straight Truck?

Do You Have Straight Truck Experience?

Invalid Input

Invalid Input

Please List Approx. Miles (total).


Tractor & Semi-Trailer?

Do You Have Tractor & Semi-Trailer Experience?

Invalid Input

Invalid Input

Please List Approx. Miles (total).


Tractor-Two Trailers?

Do You Have Tractor-Two Trailers Experience?

Invalid Input

Invalid Input

Please List Approx. Miles (total).


Tractor-Three Trailers (triples)?

Do You Have Tractor-Three Trailers Experience (triples)?

Invalid Input

Invalid Input

Please List Approx. Miles (total).


Other Class?

Do You Have Another Class Type?

Please List Type of Equipment

Invalid Input

Invalid Input

Please List Approx. Miles (total).

Please list ALL states operated in for the last FIVE years:

Please list any special courses/training competed (PTD/DDC, Haz Mat, etc.):

Please list any Safe Driving Awards you hold and from whom.

Did you have ANY Accidents over the past three years?

Did you have ANY Accidents over the past three years?
Invalid Input

Please list the nature of your accident (Head on, rear end, upset, etc.)

Please list the location of your accident.

Please list the # of fatalities of your accident.

Please list the # of people injured in your accident.


Any Other Accidents?

Did you have any other accidents?

Invalid Input

Please list the nature of your accident (Head on, rear end, upset, etc.)

Please list the location of your accident.

Please list the # of fatalities of your accident.

Please list the # of people injured in your accident.


Any Other Accidents?

Did you have any other accidents?

Invalid Input

Please list the nature of your accident (Head on, rear end, upset, etc.)

Please list the location of your accident.

Please list the # of fatalities of your accident.

Please list the # of people injured in your accident.


Did you have ANY Convictions and Forfeitures over the past three years? (other than parking violations)

Did you have ANY Convictions and Forfeitures over the past three years? (other than parking violations)
Invalid Input

Please list the location of your Traffic Conviction.

Please list the charge of your Traffic Conviction.

Please list the penalty of your Traffic Conviction.


Any Other Traffic Convictions?

Did you have any other Traffic Convictions?

Invalid Input

Please list the location of your Traffic Conviction.

Please list the Charge of your Traffic Conviction.

Please list the Penalty of your Traffic Conviction.


Any Other Traffic Convictions?

Did you have any other Traffic Convictions?

Invalid Input

Please list the location of your Traffic Conviction.

Please list the Charge of your Traffic Conviction.

Please list the Penalty your Traffic Conviction

 

Driver’s License

(list each driver’s license held in the past three years)

Please list the State of your Driver's License.

Please list your Driver's License #

Please list your License Type

Please list your License Endorsements

Invalid Input


Any Other Driver License's?

Did you have any other Driver License's?

Please list the State of your Driver's License.

Please list your Driver's License #

Please list your License Type

Please list your License Endorsements

Invalid Input


Any Other Driver License's?

Did you have any other Driver License's?

Please list the State of your Driver's License.

Please list your Driver's License #

Please list your License Type

Please list your License Endorsements

Invalid Input

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Please explain details.

Has any license, permit or privilege ever been suspended or revoked?

Has any license, permit or privilege ever been suspended or revoked?
Please explain details.

Is there any reason you might be unable to perform the functions of the job for which you have applied? (as described in the job description)

Is there any reason you might be unable to perform the functions of the job for which you have applied ?
Please explain why.

 

References

List three persons for references, other than family members, who have knowledge of your safety habits.

1

Please List Your Reference Name.

Please List Their Contact Phone Number.

Please List How You Know Them.

Please List How Long You've Know Them.


2

Please List Your Reference Name.

Please List Their Contact Phone Number.

Please List How You Know Them.

Please List How Long You've Know Them.


3

Please List Your Reference Name.

Please List Their Contact Phone Number.

Please List How You Know Them.

Please List How Long You've Know Them.


Please list any additional comments to help us evaluate your employment.

APPLICANTS STATEMENT: PLEASE READ AND AGREE

I hereby declare that the information provided by me in this Application for Employment is true, correct and complete to the best of my knowledge. I authorize Sunflower Paving, Inc. to investigate my past and present employment, education and activities and verify all data provided by me on this application, on related papers and in interviews. I authorize all individuals, schools and/or firms named herein (except my current employer, if so noted) to provide any information requested about me. I release from all liability any persons, companies, corporations or educational institutions supplying such information. I release Sunflower, Inc. from any and all liability resulting from the verification of such information. I understand that any false statement or omission of fact on this application or on any supporting documents shall be grounds for non-hire or discharge, regardless of when discovered by Sunflower Paving, Inc.

You MUST AGREE To the Applicant Statement listed ABOVE.

Invalid Input

785-856-4590

1457 N 1823 Road

Lawrence, KS 66044

Office 785-856-4590

Fax 785-856-4594

amy@sunflowerpaving.com

Office Hours

Monday - Friday

8:00 am - 5:00 pm

Weekends

Closed

Our Paving Services

  • County Highways
  • Municipal Street Overlays
  • Asphalt Patching
  • Parking Lots
  • Driveways
  • Curbs
  • Sidewalks
  • Handicap Ramps