Driver Employment Application

Lloyd Brothers Logistics

8735 Dunwoody Pl ste 4713

Atlanta, GA 30350

(404) 808-9557

[email protected]

Please give complete answers to ALL questions -

Incomplete answers will only slow, or stall the application and our goal is to get you hired quickly.

Thank you for your time.

APPLICANT INFORMATION

First Name *

Last Name *

Date of birth *

Phone Number *

Email Address *

Current Address:

Address *

Street Address

City

State

Country

Postal code

How long at current address? *

Previous Address (if less than 3 years at current address):

Previous Street Address

Previous City

Previous State

Previous Postal Code

Emergency Contact:

Emergency Contact Name: *

Emergency Contact Relationship *

Emergency Contact Phone Number *

POSITION INFORMATION

Position Applying For:
Over-the-Road (OTR) Driver

Date Available to Start *

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

Do you have a valid Commercial Driver's License (CDL)? *

What CDL Class do you have? *

State of Issuance *

CDL Number *

CDL Expiration Date *

Do you have a current DOT medical card? *

Have you ever been convicted of a felony? *

If yes, please explain:

DRIVING EXPERIENCE

Total Years of Driving Experience *

If other, please list below

List states operated in during the last five years *

Have you been in any accidents in the last three years? *

If yes, please complete the following below

Date of Accident

What was the nature of the accident?

Were there any injuries or fatalities?

Have you had any traffic violations in the last three years?

Date of Last Traffic Violations

Type of Violation

Location of Violation

EMPLOYMENT HISTORY

List all employment for the past three years. If applying to operate a commercial vehicle, provide 10 years of employment history.

Current or Most Recent Employer:

Is this your Current Employer?

Yes

Company Name of Employer *

Employer Address *

Employer Phone Number *

Employer Supervisor Name *

Position Held *

Dates of Employment: From *

Dates of Employment: To *

Reason for Leaving *

Were you subject to DOT regulations? *

Was this a safety-sensitive position? *

Previous Employer:

Previous Employer Name

Previous Employer Address

Previous Employer Phone Number

Previous Employer Supervisor

Previous Position Held

Previous Dates of Employment: From

Previous Dates of Employment: To

Reason for Leaving Previous Employment

Were you subject to DOT regulations for this position?

Was there a safety-sensitive requirement for this position? *

EDUCATION

High School *

High School Location *

Graduated from High School *

College/Trade School

College/Trade School Location

Graduated from College/Trade School

Degree or Certification

REFERENCES

(List three professional references not related to you.)

Reference 1 Name *

Reference 1 Phone

Reference 1 Relationship

Reference 2 Name

Reference 2 Phone

Reference 2 Relationship

Reference 3 Name

Reference 3 Phone

Reference 3 Relationship

CERTIFICATION AND CONSENT *

I certify that the information provided in this application is true and complete. I authorize the company to investigate my driving history, criminal background, and employment history. I understand that any false statements may result in disqualification or termination of employment.

Document Upload

Front of Drivers License *

Please upload file as JPG, PNG, or PDF

Be sure to upload a clear, legible image of the entire document, including all four corners and ensuring the front is visible

Back of of Drivers License *

Please upload file as JPG, PNG, or PDF

Be sure to upload a clear, legible image of the entire document, including all four corners and ensuring the back is visible

DOT Medical Card

Please upload file as JPG, PNG, or PDF

Be sure to upload a clear, legible image of the entire document, including all four corners and ensuring the front and back are visible

Social Security Card

Please upload file as JPG, PNG, or PDF

Be sure to upload a clear, legible image of the entire document, including all four corners

Applicant Signature

Clear

Today's Date

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