Stidham Trucking, Inc. Driver Recruitment Program Application

Driver Qualification Proposal: Owner Operator Work History

This is the fourth of 5 pages of the Application Form which you can fill out and submit by e-mail. Please complete and submit Pages 1 Personal Information, 2 Driver License Information, and 3 Driving Experience, before you fill out the form below:

Name:
Your email:
 
List all employment, full and part time, of the past 10 years. If you were leased to a motor carrier, list that carrier as an employer even if you were an independent contractor. Indicate any period of unemployment exceeding 60 days. Start with the most current or present position and work backwards. If you do not fully complete this section, your application will be delayed.
Most Current/Present Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Previous Position Date From (Mo/Yr): To (Mo/Yr):
Company name:
Telephone:
Address:
City:
State:
Zip:
Supervisor:
Position Held:
Compensation:
Full/Part Time?:
Reason for Leaving?
Type Vehicle Driven:
Number Miles per Month?
States Driven In?
Number Accidents:
Were you permanently leased to another carrier? Which one?:
Were you sbuject to the FMCSR's while employed?
Was your job designated as a safety-sensitive function in any DOT regulated mode subject ot the drug and alcohol testing requirements of 49 CFR part 40?
Have you ever been convicted of a felony? Yes: No: Date:
Have you ever been convicted of any drug-related offense? Yes: No: Date:
Were you ever discharged by an employer because of an accident? Yes: No: Date:
 


After submitting Work History above, please continue with the final page of the Application Form: Health Record and References
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Yreka, California 96097
1-800-827-9500
530-842-4161
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