Employment Application

Are you at least 18 years of age?*
YesNo

Have you ever filed an application with us before?*
YesNo

Have you ever worked for our company in the past?*
YesNo

Are you able to perform the essential job functions of the position for which you are applying?*
YesNo

If hired, are you able to submit verification of your legal right to work in the United States?*
YesNo

DRIVER LICENSE INFORMATION - FMCSA Required Information

List DRIVER'S LICENSE NUMBER and the following formation. Please include your CURRENT, valid license plus past 3 years including permits.

EMPLOYMENT EXPERIENCE

Begin with your most current employer.
Non-CDL Holders: List names and addresses of previous employers during the last THREE years.
CDL Holders: List names and addresses of previous employers during the last TEN years. (This is a DOT requirement.)

Reason for Leaving*

EDUCATION

MOTOR VEHICLE ACCIDENTS

Have you had any motor vehicle accidents in which you were involved in the past 3 years?*
YesNo

TRAFFIC VIOLATIONS

Have you had any motor vehicle laws or ordinances (other than violations involving parking only) of which you were convicted or forfeited bond or collateral in the past 3 years?*
YesNo

REVOCATIONS AND SUSPENSIONS

Have you ever had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended?*
YesNo

SPECIAL SKILLS AND QUALIFICATIONS

Summarize special job-related skills and qualifications acquired from employment and other experience.

For ex. List types of heavy equipment, you can operate and # of years of experience (skid loaders, back hoes, front end loaders, asphalt milling machines, etc.)
Any certificates you may hold ex OSHA 10 or 30, HazMat, Demolition, etc.

EQUAL EMPLOYMENT OPPORTUNITY

Your answers to the following four questions are entirely optional.
This information will not be used as selection criteria. If you'd rather not share this information, feel free to select "Decline to Answer".

TO BE READ AND SIGNED BY APPLICANT

Note: Previous employer(s) may be contacted, and information provided may be used to investigate the applicant's background. Per 391.23(i), (due process rights) the employee can request information received as part of the background investigations completed.

(i)(1)(i) The right to review information provided by previous employers;
(i)(1)(ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (i)(1)(iii) The right to have a rebuttal statement attached to the alleged erroneous information, If the previous employer and the driver cannot agree on the accuracy of the information. (For a more detailed explanation of the driver's rights please see FMCSR 391.23)

"This certifies that the application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize Minnesota Roadway Company to make an investigation of any of the facts set forth in this application."

All offers of employment are conditional upon satisfactory reference checks. Successful completion of a physical exam and drug test is required for certain classifications.

I am aware that a consumer report (motor vehicle record) will be obtained on me in the course of consideration for employment.

I hereby authorize, without reservation, any party, state, or agency contacted by Minnesota Roadways Co., to furnish the above-mentioned information. I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.

I agree that by signing my name electronically I understand that my electronic signature is the legal equivalent of my manual signature on this form.