Fayetteville Contractors, APPLICATION FOR EMPLOYMENT Inc. P.O. Box 610 CDL License Fayetteville, PA 717-352-2186 Applicant’s Name 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 you have answered A or B with Yes, Explain Employment Record Note: Federal Motor Carrier Safety Regulations (FMCSR(s)) and U.S. Department of Transportation (DOT) requires that employment for at least 3 years and/or Commercial Driving experience for the past 10 years be shown (attached if additional space is needed). Most recent employer Name: (Street) (City) & Zip Code) Position From To Held Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No Second last employer Phone Name: (Street) (City) (State & Zip Code) Position From To Held Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No Third last employer Phone Name: (Street) (City) (State & Zip Code) Position From To Held Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No
Fayetteville Contractors, Inc. APPLICATION FOR EMPLOYMENT P.O. Box 610 CDL License Fayetteville, PA 717-352-2186 Applicant’s Name 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 you have answered A or B with Yes, Explain Employment Record Note: Federal Motor Carrier Safety Regulations (FMCSR(s)) and U.S. Department of Transportation (DOT) requires that employment for at least 3 years and/or Commercial Driving experience for the past 10 years be shown (attached if additional space is needed). Most recent employer Name: (Street) (City) & Zip Code) Position Held From To Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No Second last employer Name: Phone (Street) (City) (State & Zip Code) Position Held From To Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No Third last employer Name: Phone (Street) (City) (State & Zip Code) Position Held From To Reasons for Leaving Were you subject to the FMCSR’s while employed by previous employer? Yes No Was job designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49CFR Part 40? Yes No
Employment-Application-CDL-License.docx