Driver Application

Gordon Trucking Online Driver Application

Position Applied For:
Name:
Social Security #:
Present Address:
City:
State:
Zip Code:
Telephone #, Including Area Code:
Email Address
Date Of Birth:

Drivers License Information:

State:
License #:
Expiration Date:
CDL:	Yes No
# Of Years OTR Exp.:
# Of Tickets Last 3 Years:
Have You Ever Been Convicted Of A DWI?	Yes No
# Of DWI Within Last 7 Years
Has Your License Been Suspended Or Revoked?	Yes No
If Yes, When And Why?

Accident Information:

Date	Nature Of Accident (Rear-End, Fixed Object, Right Turn, Etc.)	Injuries	Damages (Total Dollar Loss)	Preventable
				Yes No
				Yes No

Employment History (Must List Last 5 Years):

Present Or Last Employer:
Dates Of Employment:	From To
Present Employer:
Address:
City:
State:
Zip Code:
Telephone #, Including Area Code:

Second Last Employer:

Dates Of Employment:	From To
Present Employer:
Address:
City:
State:
Zip Code:
Telephone #, Including Area Code:

Third Last Employer:

Dates Of Employment:	From To
Present Employer:
Address:
City:
State:
Zip Code:
Telephone #, Including Area Code:

GTI Follows All DOT Regulations Regarding Drug And Alcohol Testing

I certify that I personally completed this application and that all of the information is true and correct. I authorize Gordon Trucking, Inc. to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Gordon Trucking, Inc. and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Gordon Trucking, Inc., Inc. by whatever means is most expedient.

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