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Driver Application

Upon your submission of this online application form, our Driver Recruiter will contact you regarding your initial qualifications for employment. If you have any questions, please contact Rowdy Durci or Alan Bauman .

* = required
First Name*
Middle Initial
Last Name*
Address Line 1*
Address Line 2
Address Line 3
City*
State*
Zip Code*
Confirm Email*
Phone Number*
Date of Birth*

Can you provide proof of age?*
Yes No
Rate of Pay Expected
$
Do you have the legal right to work
in the United States?*
Yes No
Select 1 or more Divisions interested in*
 Flat Bed
 Dry Van
 Dry Bulk
 Sand (Bulk Tank & Sand Box)
Which of the following
are you looking to be?*
 A Company Driver
 An Owner Operator
Have you previously worked for
Wayne W. Sell Corporation?*
 Yes  No
If so, when?
Where you referred?
 Yes  No
If so, by whom?
Have you ever been bonded?
 Yes  No
If so, Name of Bonding Co.
Have you ever been convicted of a felony*
 Yes  No
If yes, please explain below.

Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.

Last School Attended:*

City*

State*
Highest education completed*
 Grades 1-8
 High School - Grade 9
 High School - Grade 10
 High School - Grade 11
 High School - Grade 12
 College - 1yr
 College - 2yr
 College - 3yr
 College - 4yr
 5 or More Years of College/Post-College Education

List all driver licenses held in the past 3 years*


Current License*
State*

Number*

Type*

Expiration Date*

Past License 1
State

Number

Type

Expiration Date

Past License 2
State

Number

Type

Expiration Date

Past License 3
State

Number

Type

Expiration Date

Please provide the names of your employers for the past 7 years
Please check the vehicles below for which you have driving experience:
 Straight Truck
 Tractor-Two Trailer
 Motorcoach-School Bus
 Tractor & Semi-Trailer
 Tractor-Three Trailer
 Other
If you chose "Other" checkbox for vehicle experience, please explain
How many years of driving experience do you have?*
Please check if you have had any of the below accident types in the past three years
 Head-On
 Fatalities
 Hazardous Materials Spill
 Rear-End
 Injuries
 Charges
 Upset
Accident Concequences: (Please explain what resulted)
List any special driver training/courses that will help you as a driver:
Do you hold safe driving awards? Please List:
List any trucking, transportation or other industry experience:
List special equipment or technical materials you can work with:
* = required
* I agree to the Background Report Disclosure as defined below
(You can access a copy of this form by clicking: Background Report Disclosure Form)

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Wayne W. Sell Corporation (“Prospective Employer”), its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were

reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize Wayne W. Sell Corporation (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP)system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

* I consent to the drug and alcohol terms as defined below
(You can access a copy of this form by clicking: Drug and Alcohol Consent Form)

General Consent for Limited and Full Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I hereby provide consent to Wayne W. Sell Corporation to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This consent is granted for pre-employment purposes, as well as a yearly query as required by the regulation. I also grant consent to Wayne W. Sell Corporation to conduct those queries the Company deems necessary to comply with the regulation. This consent remains in affect for the duration of my employment with Wayne W. Sell Corporation. Upon my separation with Wayne W. Sell Corporation; this consent is terminated.

I understand that if the limited query conducted by Wayne W. Sell Corporation indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Wayne W. Sell Corporation without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for Wayne W. Sell Corporation to conduct a limited query of the Clearinghouse, Wayne W. Sell Corporation must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.

* I agree to the DOT compliance requirements as defined below
(You can access a copy of this form by clicking: DOT Compliance)

Motor Vehicle Driver's

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. They are as follows:

  1. POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator's license.
  2. NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.15(b)(2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver's license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other than parking), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state that issued your license (If the violation occurs in a state other than the one which issued your license). The notification to both the employer and the state must be in writing.
* I agree to the terms as defined below:
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. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company.