On-Line Application

General Information

Your Name(required)
Email(valid email required)
Social Security Number
Date
Position Applied For

Current & 3-years Previous Addresses

Address, City, ST, Zip
From
To
Address, City, ST, Zip
From
To
Address, City, ST, Zip
From
To

Employment History

Give a Complete Record of all employment for the past three years, including any unemployment or self employment, and all commercial driving experience for the past ten years.
Present or Last Employer Name
From
To
Address, City, ST, Zip
Position
Salary
Reason for Leaving
Previous or Last Employer Name
From
To
Address, City, ST, Zip
Position
Salary
Reason for Leaving
Previous or Last Employer Name
From
To
Address, City, ST, Zip
Position
Salary
Reason for Leaving

Driving Experience

Class of Equipment
From
To
Approx Number of Miles
Class of Equipment
From
To
Approx Number of Miles
Class of Equipment
From
To
Approx Number of Miles
List states operated in for last 5 years
List special courses or driver training
List any Safe Driving Awards and from whom

Accident Record

Date (if applicable)
Nature of Accident
Number of Fatalities
Number of People Injured
Date (if applicable)
Nature of Accident
Number of Fatalities
Number of People Injured
Date (if applicable)
Nature of Accident
Number of Fatalities
Number of People Injured

Traffic Convictions & Forfeitures in Last 3 Years

1st Conviction Location
Date
Charge
Penalty
2nd Conviction Location
Date
Charge
Penalty
3rd Conviction Location
Date
Charge
Penalty

Driver's Licenses

State
License #
Type
Endorsements
Expiration Date
State
License #
Type
Endorsements
Expiration Date
State
License #
Type
Endorsements
Expiration Date
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
A: Denied?
YES NO
Has any license, permit, or privilege ever been suspended or revoked?
B: Expired?
YES NO
If answer to A or B is YES, give details

Personal References

Name(required)
Address, City, ST, Zip(required)
Name(required)
Address, City, ST, Zip(required)
Name(required)
Address, City, ST, Zip(required)

To be read and signed by Applicant

It is agreed and understood that any misrepresentation given shall be considered an act of dishonesty. It is agreed and understood that Hammer Down Delivery or its agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases contractor and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigating Consumer Report, including information regarding my character, general reputation, and personal characteristics! I agree to furnish such additional information and complete such examinations as may be required to complete my driver file. It is agreed and understood that this application for qualification in no way obligates the contractor to lease the applicant. It is agreed and understood that if qualified, the applicant may be on a probationary period during which time he/she may be disqualified without recourse. Furthermore, I understand that my lease would be “at will”, and may be terminated by either me or the contractor at any time, for no reason or for any reason not contrary to law, with or without notice. I understand that there are no provisions that modify or amend the “at will” nature of my lease with Hammer Down Delivery. 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. By filling out my name and date below and submitting this application, I am supplying an "electronic signature" of agreement to all items stated above.
Electronic Signature(required)
Date(required)