DOT APPLICATION FOR EMPLOYMENT

Position desired *

Date *

How did you learn about us?

Name *

First

Middle

Last

Date of birth

Social security

Address

Address Line 1

Address Line 2

City

State

Zip Code

If your above address is less than three (3) years, continue them below to cover the previous three (3) year period.

Address 1

Address Line 1

Address Line 2

City

State

Zip Code

Address 2

Address Line 1

Address Line 2

City

State

Zip Code

Address 3

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Are you over eighteen (18) years of age?

Yes
No

Are you twenty-one (21) years of age (for interstate or hazardous materials)?

Yes
No

*Company will not publicly display SSN on any access card, require any SSN for a personal identification, or print SSN on any mailing
except as required by law.

Have you ever filed an application with us before?

Yes
No

Have you ever worked for Blue Diamond Carriers LLC?

Yes
No

If so, when?

Are you able to perform the duties of the job for which you are applying?

Yes
No

If no, please describe

Are you currently employed?

Yes
No

May we contact your present employer?

Yes
No

Are you legally authorized to work in the United States?

Yes
No

Proof of identity and work authorization will be required upon employment.

On what date would you be available for work?

Availability

Have you ever been convicted or pled guilty or no contest to a felony offense?

Yes
No

If yes, please explain.

For purposes of employment with Blue Diamond Carriers LLC, “convictions” include, but are not limited to, sentenced to confinement, paid fine, time served, placed on probation (including deferred adjudication), and court-ordered restitution.

Please explain

*Conviction of a felony will not necessarily bar you from employment.

I, , agree to immediately notify Blue Diamond Carriers LLC if I am convicted of, receive deferred adjudication in, or otherwise plead guilty or no contest to a felony or any crime involving dishonesty or a breach of trust while my application is pending or during my period of employment, if hired.

Signature

Click or drag a file to this area to upload.

Please upload signature

Date

Education

Highest grade completed in school.

Selected Value: 0

Name, address, city, and state of last school attended:

Vocational or Business Schools Attended:

List names of friends or relatives now employed by Blue Diamond Carriers LLC.

PERSON TO CONTACT IN CASE OF AN EMERGENCY

This information is to facilitate contact in the event of an emergency and is not used in the selection process.

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Place of employment

Address

Address Line 1

Address Line 2

City

State

Zip Code

Their Relationship to You

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT HISTORY FOR LAST TEN (10) YEARS

Start with your present or last job. You may also include any activities which you believe demonstrate your qualifications for the position applied. If applicant is too young to have an employment history going back ten (10) years, include schools attended or whatever applicant was doing. (Attach additional sheets if necessary)

CURRENT OR MOST RECENT EMPLOYER:

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor: Dates of Employment: to Positions/Duties:

Reason for Leaving:

Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?

Yes
No

Were you subject Federal Motor Carriers Safety Regulations (FMCSR)?

Yes
No

NEXT PREVIOUS EMPLOYER

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor: Dates of Employment: to Positions/Duties:

Reason for Leaving:

Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?

Yes
No

Were you subject Federal Motor Carriers Safety Regulations (FMCSR)?

Yes
No

File Upload

Click or drag a file to this area to upload.

ACCIDENT RECORD AND TRAFFIC CONVICTIONS

Include vehicles having a GVWR of 26,001 lbs. or more (or 10,000 lbs. for interstate), vehicles designed to transport fifteen (15) or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Accident Record for past three (3) years or more (attach sheet if more space is needed). If none, write “none”.

Date

Type of Vehicle

Nature of Accident (Head-On, Rear-End, Upset, Etc.)

Fatalities

Injuries

File Upload

Click or drag a file to this area to upload.

List all violations of motor vehicle laws or ordinances (other than parking violations) of which you were convicted, forfeited bond, or collateral during the past three (3) years.

Location Date Charge Penalty

EXPERIENCE AND QUALIFICATIONS – DRIVER

List of Drivers licenses

State, License No., Type, Expiration Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes
No

Has any license, permit, or privilege ever been suspended or revoked?

Yes
No

Include a detailed explanation of the facts and circumstances for each denial, revocation, or suspension.

Driving Experience (If None, Write “None”)

Class of Equipment

Please specify

Type of Equipment
(Van, Tank, Flat, Etc.),
Date Range,
Approx. No. of Miles (Total)

List states operated in for last five (5) years.

Show special courses or training that will help you as a driver.

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 those shown elsewhere in this application.

List special equipment or technical materials you can work with (other than those already shown).

DRUG TESTING 49 CFR 40.25(j)

Have you ever tested positive or refused to test on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years?

Yes
No

If YES — Have you successfully completed the return to duty process?

Yes
No

If YES — Documentation MUST BE PROVIDED before any safety-sensitive transportation function is performed.

Yes
No

If yes, please give details.

Our business is a subscriber to Workers’ Compensation of Texas.

Date

Signature

Click or drag a file to this area to upload.

RIGHTS REGARDING SAFETY PERFORMANCE HISTORY INFORMATION
The information you provided on this application may be used, and the applicant’s prior employers may be contacted, for the purpose of investigating the applicant’s safety performance history information. Pursuant to Federal Motor Carrier Safety Regulations 49 CFR Sec. 391.23 (i)(1), you have the following rights with regard to the safety performance history information provided by your previous employers.

THE RIGHT TO REVIEW SAFETY PERFORMANCE RECORDS
You have the right to review the records provided by your previous employers. You must make your request to review in writing and submit it to your prospective employer no later than thirty (30) days after employment begins or notification of employment is made. You will be provided with the records within five (5) business days of receipt of your written request. If the prospective employer has not received the records at the time of your request, then the five (5) day period to provide access will begin on the day the records are received from the previous employer. If you fail to arrange to pick up or receive the requested records within thirty (30) days of when they are first made available to you, then your right to review is considered waived.

THE RIGHT TO HAVE ERRONEOUS INFORMATION CORRECTED
If you believe there is an error in the records, you have the right to have your previous employer correct the error. Send your request for correction to the previous employer that provided the records in question. The previous employer must either correct and forward the record to the prospective employer or notify you within fifteen (15) days of receiving your request that they do not agree the record is in error. If the previous employer corrects and forwards the record as requested, that employer must also retain the corrected information as part of your safety performances history record and provide it to subsequent prospective employers when requests for this information are received.

THE RIGHT TO REBUT DISPUTED INFORMATION
If the previous employer does not agree that information in the records provided is in error, you may rebut the disputed information in writing and send it to the previous employer with instructions to include the rebuttal in your safety performance history file. Within five (5) business days of receiving your rebuttal, the previous employer must; forward a copy of the rebuttal to the prospective employer; append the rebuttal to your safety performance information and include it as part of the response for any subsequent investigating prospective employers for the duration of the three (3) year data retention requirement period. You may submit a rebuttal initially without a request for correction, or subsequent to a request for correction.

THE RIGHT TO REPORT FAILURES TO CORRECT ERRONEOUS INFORMATION
You may report failures of a previous employer to correct information or include your rebuttal as part of the safety performance, to the Federal Motor Carrier Safety Administration by following procedures specified at 49 CFR Section 386.12.

Click or drag a file to this area to upload.

Date Signature of Employer's Representative Signature of Employee Print Name

Education

PERSON TO CONTACT IN CASE OF AN EMERGENCY

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT HISTORY FOR LAST TEN (10) YEARS

CURRENT OR MOST RECENT EMPLOYER:

NEXT PREVIOUS EMPLOYER

ACCIDENT RECORD AND TRAFFIC CONVICTIONS

EXPERIENCE AND QUALIFICATIONS – DRIVER

Driving Experience (If None, Write “None”)

EXPERIENCE AND QUALIFICATIONS – OTHER

DRUG TESTING 49 CFR 40.25(j)

Contact us

Information

Follow us