Driver Job Application - Full Service Logistics Company - Bettaway Beverage Distributors Inc

Personal Info

Location Applying for*

First Name*

Middle Name

Last Name*

Phone*

Email*

Years hauling a 53' trailer?*

Years*Months*

Are you an owner operator?

Yes

Current Address

Number and Street*

City*

State*

Zip*

Phone*

How Many Years*

Months*

Background Questions

Are you authorized to work in the U.S. for any employer?*

Will you now or in the future require Bett-A-Way to sponsor you for a U.S. work visa?*

Are you at least 21 years of age?

Yes

Can you provide proof of age?*

Yes

Have you worked for this company before?*

Yes

Location

Date From

Date To

Previous Rate of Pay

Position

Reason for leaving

Were you referred?

Yes

If so, by whom?

Can you perform the essential functions of the job with or without reasonable accommodation?*

Yes

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Have you had an accident, DWI or traffic violation in the last 3 years?*

Yes

Accident History (For the past three years, starting with the most recent)

Date

Nature of Accident (write-in or choose)

Any fatalities?

Any injuries?

Hazardous Material Spill?

Yes

Conviction/Forfeiture History (For the past three years, starting with the most recent. Do not include parking violations)

Location	Date	Charge	Penalty

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. Applicant to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle. NOTE List employers in reverse order starting with the most recent.


Employer 1 Employer Name* Date From* Date To* Position Held* Number and Street* City* State* Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code* Phone* Contact Person*
Employer 2 Employer Name Date From Date To Position Held Number and Street City State Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Phone Contact Person
Employer 3 Employer Name Date From Date To Position Held Number and Street City State Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Phone Contact Person

Experience and Qualifications

Driver Licenses and Permits held in the past three years

State	Class	Endorsements
Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Select One Class A Class B	Select One Hazmat Doubles Triples Tankers
Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Select One Class A Class B	Select One Hazmat Doubles Triples Tankers
Select One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Select One Class A Class B	Select One Hazmat Doubles Triples Tankers

License Problems. Please check any boxes that apply

License/Permit Denied

License/Permit Suspended

License/Permit Revoked

Please provide details about any denial, suspension or revocation of your license

Commercial Driving History

Vehicle Type	Number of Passengers	From	To	Approx No of Miles
Select One Straight Truck Tractor and Semi Trailer Tractor - Two Trailers Tractor - Three Trailers Motorcoach - School Bus Other	Select One 1-8 9-15 16 +
Select One Straight Truck Tractor and Semi Trailer Tractor - Two Trailers Tractor - Three Trailers Motorcoach - School Bus Other	Select One 1-8 9-15 16 +
Select One Straight Truck Tractor and Semi Trailer Tractor - Two Trailers Tractor - Three Trailers Motorcoach - School Bus Other	Select One 1-8 9-15 16 +

States operated in for the last five years (Use Ctrl or Shift for multiple selection)

Select One
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY

Any special courses or training that will help you as a driver?

Submit Application

Select One
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY