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Home
Freight Hauling Requests
Employment
Online Driver Application
About
Related Resources
Contact
Driver Application
ONLINE DRIVER APPLICATION
1
Basic
2
Physical
3
History
4
Experience
Laughlin Trucking Application
Position applying for:
Position
Full Name
FullName
DOB (Month/Day/Year)
DOB
Phone #
Phone
SSN
SSN
Are you eligible to work in the US?
Yes
No
EligibleForUSWork
Address History
Street Address 1
Addr1
City
Addr1City
State
Addr1State
Zip Code
Addr1Zip
How long?
Addr1HowLong
Second Most Recent Address
Street Address 2
Addr2
City
Addr2City
State
Addr2State
Zip Code
Addr2Zip
How long?
Addr2HowLong
Emergency Contact
Name
EmergencyContact
Phone
EmergencyPhone
Relation
EmergencyContactRelation
Previous Laughlin Employment
Have you worked for this company before?
Yes
No
PreviousLaughlinEmployment
What position?
FormerEmploymentPosition
Date From
Date From
Date To
Date To
Reason For Leaving
Reason For Leaving
Current Employment
Are you currently employed?
Yes
No
Current Employment
How long since leaving last employment?
Time Since Last Employment
Referral & Desired Pay Rate
Who referred you?
Referred By
Desired Pay Rate
Desired Pay Rate
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Physical Condition
List any limitations that prevent you from performing the duties of a commericial motor vehicle driver. Specify any medical waivers.
Physical Limitations
Are you physically capable of heavy manual work?
Yes
No
Physically Capable of Manual Work
Would you be willing to take an examination?
Yes
No
Examination
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Employment History
Applications for positions that require the driving of commercial motor vehicles must provide an additional 7 years information on those employers for whom the applicant operated such vehicles, or up to 10 years employment history.
Employer #1
Employer Name
Employer 1
From
Employer 1 From
To
Employer 1 To
Address
Employer 1 Address
City
Employer 1 City
State
Employer 1 State
Zip
Employer 1 Zip Code
Position
Employer 1 Position
Reason For Leaving
Employer 1 Reason For Leaving
Contact Person
Employer 1 Contact
Contact Phone
Employer 1 Contact Phone
Did you operate vehicles weighing 10,001 lbs or more?
Yes
No
Employer 1 - 10k lbs or More
Were you subject to Part 382: drug and alcohol rules?
Yes
No
Employer 1 - Part 382
Employer #2
Employer Name
Employer 2
From
Employer 2 - From
To
Employer 2 - To
Address
Employer 2 - Address
City
Employer 2 - City
State
Employer 2 - State
Zip
Employer 2 - Zip Code
Position
Employer 2 - Position
Reason For Leaving
Employer 2 - Reason For Leaving
Contact Person
Employer 2 - Contact
Contact Phone
Employer 2 - Contact Phone
Did you operate vehicles weighing 10,001 lbs or more?
Yes
No
Employer 2 - Operating Weight 10k lbs or More
Were you subject to Part 382: drug and alcohol rules?
Yes
No
Employer 2 - Part 382
Employer #3
Employer Name
Employer 3 - Name
From
Employer 2 - From
To
Employer 3 - To
Address
Employer 3 - Address
City
Employer 3 - City
State
Employer 3 - State
Zip
Employer 2 - Zip
Position
Employer 3 - Position
Reason For Leaving
Employer 3 - Reason For Leaving
Contact Person
Employer 3 - Contact Person
Contact Phone
Employer 3 - Contact Phone
Did you operate vehicles weighing 10,001 lbs or more?
Yes
No
Employer 3 - Weight 10K or More
Were you subject to Part 382: drug and alcohol rules?
Yes
No
Employer 3 - Part 382
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Driving History and Experience
Please list any motor vehicle accidents in the past 3 years. If not applicable, write "N/A"
Accident #1 Date
Accident 1 Date
Nature of Accident
Accident 1 Description
Fatalities?
Accident 1 - Fatalities
Injuries?
Accident 1 - Injuries?
Accident #2 Date
Accident 2 - Date
Nature of Accident
Accident 2 - Description
Fatalities?
Accident 2 - Fatalities
Injuries?
Accident 2 - Injuries
Accident #3 Date
Accident 3 - Date
Nature of Accident
Accident 3 - Description
Fatalities?
Accident 3 - Fatalities
Injuries?
Accident 3 - Injuries
Please list any traffic violations or convictions in the past 3 years. If not applicable, write "N/A"
Traffic Violation #1 Date
Traffic Violation 1 Date
Location
Traffic Violation 1 - Location
Charge
Traffic Violation 1 - Charge
Penalty
Traffic Violation 1 - Penalty
Traffic Violation #2 Date
Traffic Violation 2 - Date
Location
Traffic Violation 2 - Location
Charge
Traffic Violation 2 - Charge
Penalty
Traffic Violation 2 - Penalty
Please list any valid licenses currently held.
License #1 State
License 1 - State
License #2 State
License 2 - State
License Number
License 1 - Number
License Number
License 2 - Number
Type
License 1 - Type
Type
License 2 - Type
Expiration Date
License 1 - Expiration Date
Expiration Date
License 2 - Expiration
Please list any experience driving equipment.
Class
Type (Van, Tank, Flat, etc.)
From
To
Miles
Straight Truck
Straight Truck - Type
Straight Truck - From
Straight Truck - To
Straight Truck - Miles
Tractor / Trailer
Tractor / Trailer - Type
Tractor / Trailer - From
Tractor / Trailer - To
Tractor / Trailer - Miles
Doubles
Doubles - Type
Doubles - From
Doubles - To
Doubles - Miles
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Denied License/Permit to Operate Motor Vehicle
Has any license, permit or privilege ever been suspended or revoked?
Yes
No
License/Permit Suspended or Revoked
Explain the details of why it was suspended or revoked.
Reason for License Suspended/Revoked
In the past 2 years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test administered by an employer where you applied for a safety sensitive position and were not hired?
Yes
No
Tested Positive For Drugs/Alcohol & Not Hired
List states licensed in over the past 5 years:
Licensed States In Past 5 Years
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that the employment information I provided in the Employment History section of this application may be used, and my previous employers will be contacted, for the purpose of investigating my safety performance history information as required by 49 CFR 391.23 (d) and (e). I authorize Laughlin Trucking and its agents to contact my former employers for the purpose of fulfilling the requirements of the 49 CFR Parts 391.23 and 382.413. I further authorize Laughlin Trucking, Inc. and its agents to make any such additional inquiries beyond the FMCSR minimum requirements that are necessary to qualify this application. I do hereby release Laughlin Trucking, Inc. and its agents and any of my former employers from any and all liability which may result from obtaining and/or furnishing such information. I have received a copy of and been advised of my rights under 49 CFR 391.23(h) to (i) review information provided by previous employers upon submitting a written request within 30 days after being notified of denial of employment, (ii) have errors in information corrected, and (iii) have a rebuttal statement attached to alleged erroneous information.
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LAUGHLIN TRUCKING 2019. All RIGHTS RESERVED.
DESIGNED AND DEVELOPED BY PRIMISYS
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