BOB Transportation Inc
A REAL COMPANY FOR A REAL MAN!
Applicant information
First name
Last name
Phone
E-mail
Adress
Street
City
State
ZIP Code
DOB
SSN
Date
Position
License Information
No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that 1 do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.
State
License #
Endorsement
Expiration Date
Driving Experience
CLASS OF EQUIPMENT
TYPE OF EQUIPMENT (VAN, STEP, RGN, FLAT. ETC.)
DATE FROM
DATE TO
APPROX # OF MILES (TOTAL)
Additional Information
Accident record for the past 3 years
Attach additional sheet if more space is needed.
DATE
NATURE OF ACCIDENT (Head-on, rear-end, upset. etc.)
#FATALITIES
#CHEMICAL SPILLS
#INJURIES
Additional Information
Traffic convictions and forfeitures for the past 3 years
Attach additiunal sheet if mure space is needed.
DATE CONVICTED (Month/Year)
VIOLATION
STATE OF VIOLATION
PENALTY (Forfeited bond. collateral and/or points)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
If yes, explain
Has any license, permit, or privilege ever been suspended or revoked?
If yes, explain
EMPLOYMENT HISTORY
The Federal Motor Carrier Safety Regulations (49 CFR 391.2 I) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years ((or a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

Start wich the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, inclucling street number, city, state, zip; and complete all other information.
CURRENT (MOST RECENT) EMPLOYER
Name
Phone
E-mail
Adress
Position
From
To
REASON FOR LEAVING
SECOND (MOST RECENT) EMPLOYER
Name
Phone
E-mail
Adress
Position
From
To
REASON FOR LEAVING
THIRD (MOST RECENT) EMPLOYER
Name
Phone
E-mail
Adress
Position
From
To
REASON FOR LEAVING
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make investigations (incIuding contacting current and prior employers) into my personal, employment, financiaI, medical history, and other related matters as may be necessary in arriving at en employment decision. I hereby release employers, schooIs, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand fhat false or misleading information given in my appIication or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have ihe right to:

• Review information provided by current/previous employers;

• Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies that I completed this application, and that all entries on it and information in it are ture and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more informatinn than that required by the Federal Motor Carrier Safety Regulatinns.
Applicant Signature
Date
Applicant Name (printed)