Driver Application

To the Applicant:

We appreciate your interest in a career with Bay Corrugated Container, Inc. and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgement, best meets your qualifications.

Please complete the entire application and sign the Authorization and Understanding on the final page. this section sets forth conditions of employment that apply to all of our employees throughout their employment with our Company.

We are an equal opportunity employer and shall consider qualified applicants for all positions without regard to race, color, sex, religion, national origin, age, height, weight, martial or veteran status, or the presence of non-job related medical condition or handicap.

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 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.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by CFR 391.23(d) and (e). I understand that according to CFR 391.23(i), I have the right to:

-Review information provided by previous employers

-Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer

-Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information

-Review information provided by previous employers

-Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer

-Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Do you agree to these terms? *

Yes

Personal Information

Full Name: *

Current Address: *

Street Number and Name

Country

City

State

Zip code

Additional Address Info:

Per FMCSA Regulation 391.21(b)(3), the applicant is required to disclose any and all addresses in which the applicant has resided in the last 3 years preceding the date of which this application is submitted. Failure to report all addresses is a violation of this regulation. Please put each address on a new line.

Phone Number: *

Email Address: *

Last 4 digits of Social Security Number: *

If you are selected for an interview, you will need to bring your social security card with you.

Date of Birth: *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Have you previously been employed at Bay Corrugated Container, Inc.? *

Yes

Driver's License Information

CDL/Driver's License Number: *

State of Issuance: *

Expiration Date: *

(Of CDL-A License)

Endorsements (if any):

Employment History

Per FMCSA Regulation 391.21(b)(6), the applicant must submit any relevant information regarding the applicant's experience in the operation of a commercial motor vehicle, including the type of equipment which the applicant has operated. This section is NOT optional.

Employer 1

Current/Most Recent Employer

Employer 1 Name: *

Employer 1 Address: *

Country

City

State

Start Date: *

End Date:

Work Performed: *

Please list any relevant job duties.

Position/Title: *

Reason for Leaving (if applicable):

Employer 2

Previous Employer

Employer 2 Name:

Employer 2 Address:

Country

City

State

Start Date:

End Date:

Work Performed:

Please list any relevant job duties.

Position/Title:

Reason for Leaving (if applicable):

Additional Employment Info:

Per FMCSA Regulation 391.21(b)(6), the applicant should list at least the last 3 years of employment. If recent employment was not for a CDL-A position, please list any and all relevant experience with employer name, dates, type of equipment operated.

Driving Experience

Total years of commercial driving experience: *

Accident Information: *

Per FMCSA Regulation 391.21(b)(7), applicant must disclose any motor vehicle accidents that took place during the 3 years preceding this application's submission. Please specify the date, nature of each accident, and any fatalities or injuries caused. Please separate each accident with a semi colon for visibility ( ; ). Failure to report accidents prior to employment may result in application rejection or termination. (If the applicant has not been involved in any motor vehicle accidents, please type NONE)

Motor Vehicle Record (MVR) Authorization: *

I authorize the release of my Motor Vehicle Record (MVR) to Bay Corrugated Container, Inc. for the purpose of evaluating my eligibility for employment as a commercial motor vehicle operator.

Yes, I authorize the release of my MVR.

No, I do NOT authorize the release of my MVR.

Certification of Compliance with Drug and Alcohol Regulations: *

I certify that I am fully compliant with all Drug and Alcohol Regulations as outlined by the Federal Motor Carrier Safety Administration (FMCSA) and will adhere to all requirements while employed by Bay Corrugated Container, Inc.

Yes, I am compliant.

No, I am NOT compliant.

Electronic Signature: *

Entering your name in the text box below will be considered an Electronic Signature. Please type your full name below to submit your application for employment as a CDL-A driver at Bay Corrugated Container, Inc. A real signature will be acquired if you are selected for an interview.
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.

Additional Comments or Information:

Please use this space to provide any additional comments or information relevant to your application.