Driver Application

MOUTRIE TRUCKING DRIVER'S APPLICATION

Come Work For Us

Thank you for interest in employment with Moutrie Trucking!  We value long-term relationships and take pride in low driver turnover.  We hold our drivers to high professional standards as public safety, on-time delivery, and commitment to customer service are essential.

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

Driver's Application
MM/DD/YYYY
Street Address
2nd Street Address
City
State/Province
Zip/Postal
Street Address
2nd Street Address
City
State/Province
Zip/Postal
Street Address
2nd Street Address
City
State/Province
Zip/Postal

Employment Information

All employee will be required to fill out an I-9 form
We are not able to accept your application at this time. Once you have obtain legal status to work in the U.S., you are welcome to fill out this application
Conviction will not necessarily prevent employment

EMPLOYMENT HISTORY

Prospective Driver Information

Any person applying for a job as a commercial vehicle driver must inform the prospective employer of all previous employment for the previous 10 years, including all full and part time employment. All time must be accounted for including school, military service, self-employment, periods of unemployment, and time spent incarcerated for conviction of a crime. Record your present or most recent employer first. Be sure to complete all questions for each job.

NOTE: 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. weights or has a GVWR or 10,001 pounds or more
  2. is designed or used to transport 9 or more passengers, or
  3. is of any size and is used to transport hazardous materials in a quantity requiring placearding.

Employment, Education, or Other (1)

Starting with the most recent
Company Name
Street Address
City
State/Province
Zip/Postal
School Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (2)

School Name
Street Address
City
State/Province
Zip/Postal
Company Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (3)

Company Name
Street Address
City
State/Province
Zip/Postal
School Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (4)

School Name
Street Address
City
State/Province
Zip/Postal
Company Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (5)

School Name
Street Address
City
State/Province
Zip/Postal
Company Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (6)

Company Name
Street Address
City
State/Province
Zip/Postal
School Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (7)

Company Name
Street Address
City
State/Province
Zip/Postal
School Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (8)

Company Name
Street Address
City
State/Province
Zip/Postal
School Name
Street Address
City
State/Province
Zip/Postal

Employment, Education, or Other (9)

School Name
Street Address
City
State/Province
Zip/Postal
Company Name
Street Address
City
State/Province
Zip/Postal

DRIVING EXPERIENCE

Tractor and Semi-Trailer

Straight Truck

Other

 

LIST ALL DRIVER LICENSES HELD

Starting with your current license

1st Operator's License

2nd Operator's License

3rd Operator's License

4th Operator's License

 

ACCIDENT RECORD FOR THE PAST 5 YEARS

List all accidents/incidents, whether you feel you were at fault or not. Failure to disclose information may result in termination.

1st Accident Record

Start with most recent and list in chronological order
(Head-on, Rear-End, Etc.)

2nd Accident Record

(Head-on, Rear-End, Etc.)

3rd Accident Record

(Head-on, Rear-End, Etc.)

TRAFFIC VIOLATIONS/CONVICTIONS FOR THE PAST 5 YEARS

List all violations/convictions other than parking violations. Failure to disclose information may result in termination.

1st Violations/Conviction

2nd Violations/Conviction

3rd Violations/Conviction

4th Violations/Conviction

PHYSICAL FITNESS

Are you able to do the following?

EDUCATION

APPLICANT'S STATEMENT

I certify that the information included in this application is true and complete. I understand that any falsification or omission of information may result in termination of my candidacy or if hired, termination of employment.

I authorize Moutrie Trucking to conduct a thorough background investigation in accordance with state and federal laws and as required by 391.23 of the Federal Motor Carrier Safety Administration. The background investigation may include, but not limited to, ordering MVR and DAC reports. I authorize my previous and/or current employers to release any and all information requested by Moutrie Trucking including my driving/accident history and all drug and alcohol tests or refusal(s) to test. I hereby release all employers and persons named herein from all liability from the release of said information.

I understand that I have the right to review information provided by current/previous employers. I have the right to have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer. And, I have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employers and I cannot agree on the accuracy of the information.

DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Moutrie Trucking (“Prospective Employer”), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication. Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Moutrie Trucking (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear 2 on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.