Truck Driver Application

You must also download the DOT Driver Application, fill it out, and email it back to us at Korib.glc@gmail.com in order to work as a truck driver for Gale Lim Construction.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, or any other protected group status.

Position(s) Applied for
Name
First Middle Last
Social Security No.
List your addresses of residency for the past 3 years.
Current Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Address
How Long? Street City State / Province / Region ZIP / Postal Code
Previous Address
How Long? Street City State / Province / Region ZIP / Postal Code
Previous Address
How Long? Street City State / Province / Region ZIP / Postal Code
Do you have the legal right to work in the United States'?
Date of Birth
MM slash DD slash YYYY

(Required for Commercial Drivers)
Can you provide proof of age?
Max. file size: 256 MB.
Have you worked for this company before?
Where'?
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position
Reason for leaving
Who referred you?
Rate of pay expected
Have you ever been bonded?
(Answer only if a job requirment)
Name of bonding company
Can you perform, with or without reasonable accommodation, the essential functions of the job (as described in the attached job description]?
- Yes
- No
EMPLOYMENT HISTORY
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an addi-tional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
Employer
Name Address City State / Province / Region ZIP / Postal Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position held
Reason for leaving
Contact Person
Phone Number
WERE YOU SUBJECT TO THE FMCSRSt WHILE EMPLOYED?
- Yes
- No
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?
- Yes
- No
EMPLOYMENT HISTORY (continued)
Employer
Name Address City State / Province / Region ZIP / Postal Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position held
Reason for leaving
Contact Person
Phone Number
WERE YOU SUBJECT TO THE FMCSRSt WHILE EMPLOYED?
- Yes
- No
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?
- Yes
- No
Employer
Name Address City State / Province / Region ZIP / Postal Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position held
Reason for leaving
Contact Person
Phone Number
WERE YOU SUBJECT TO THE FMCSRSt WHILE EMPLOYED?
- Yes
- No
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?
- Yes
- No
Employer
Name Address City State / Province / Region ZIP / Postal Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position held
Reason for leaving
Contact Person
Phone Number
WERE YOU SUBJECT TO THE FMCSRSt WHILE EMPLOYED?
- Yes
- No
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?
- Yes
- No
'Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
'The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE

LAST ACCIDENT (DATE)	NATURE OF ACCIDENT (HEAD-ON. REAR-END. UPSET. ETC.)	FATALITIES	INJURIES	HAZARDOUS MATERIAL SPILL

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Location	Date	Charge	Penalty

Experience and qualifications - Driver

Driver licenses or permits held in the past 3 years

State	License No.	Class	Endorsement(s)	Expiration Date

A. Have you ever been denied a license. permit or privilege to operate a motor vehicle?
- Yes
- No
A. Have you ever been denied a license. permit or privilege to operate a motor vehicle?
- Yes
- No
B. Has any license, permit or privilege ever been suspended or revoked?
- Yes
- No
IF THE ANSWER TO EITHER A OR B IS YES. GIVE DETAILS
DRIVING EXPERIENCE CHECK YES OR NO
STRAIGHT TRUCK
- Yes
- No
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
TRACTOR AND SEMI-TRAILER
- Yes
- No
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
TRACTOR - TWO TRAILERS
- Yes
- No
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
TRACTOR - THREE TRAILERS
- Yes
- No
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
MOTORCOACH - SCHOOL BUS
More than 8 passengers
- Yes
- No
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
MOTORCOACH - SCHOOL BUS OTHER
- Yes
- No
More than 15 passengers
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)
Other
SELECT TYPE OF EQUIPMENT
Dates
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
APPROX NO. OF MILES (TOTAL)

LIST STATES OPERATED IN FOR LAST FIVE YEARS

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER
Max. file size: 256 MB.
WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM
EXPERIENCE AND QUALIFICATIONS - OTHER
SHOW ANY TRUCKING. TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)

EDUCATION
SELECT HIGHEST GRADE COMPLETED:
HIGH SCHOOL:
COLLEGE:
LAST SCHOOL ATTENDED
NAME
CITY
STATE
TO BE READ AND SIGNED BY APPLICANT
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.
Signature
Date
MM slash DD slash YYYY
CAPTCHA

You must also download the DOT Driver Application, fill it out, and email it back to us at Korib.glc@gmail.com in order to work as a truck driver for Gale Lim Construction.

Truck Driver Application

EMPLOYMENT HISTORY

EMPLOYMENT HISTORY (continued)

Experience and qualifications - Driver

DRIVING EXPERIENCE CHECK YES OR NO

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION

TO BE READ AND SIGNED BY APPLICANT

Any questions? Contact us.