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Driver Application

Step 1 of 3 - Personal

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Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
How Long at Current Address?*
Phone*
Email*
Available for Hire Date*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
* Please provide your social security number by phone or in person.
Previous Three Years Residency
Address & City*
State*
Zip*
# Years*
Address & City
State
Zip
# Years
Address & City
State
Zip
# Years
If you have additional residencies to add, please list them here
Personal References
List three persons for references, other than family members, who have knowledge of your safety habits.
Name*
Full Address*
Phone*
Name*
Full Address*
Phone*
Name*
Full Address*
Phone*
Education History
Select Highest Grade Completed*
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
- 9th Grade
- 10th Grade
- 11th Grade
- 12th Grade
- College - 1 Year
- College - 2 Year
- College - 3 Year
- College - 4+ Year
- Post-Graduate - 1 Year
- Post-Graduate - 2 Years
- Post-Graduate - 3 Years
- Post-Graduate - 4 Years

License Information
License Information
Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.
State*
License Number*
Type*
Expiration Date*
MM slash DD slash YYYY
Driving Experience
Class of Equipment
Straight Truck
Type of Equipment
(Van, Tank, Flat, Etc...)
Dates (From - To)
Approx. No. Miles (Total)
Class of Equipment
Tractor and Semi-Trailer
Type of Equipment
(Van, Tank, Flat, Etc...)
Dates (From - To)
Approx. No. Miles (Total)
Class of Equipment
Tractor - Two Trailers
Type of Equipment
(Van, Tank, Flat, Etc...)
Dates (From - To)
Approx. No. Miles (Total)
Class of Equipment
Other
Type of Equipment
(Van, Tank, Flat, Etc...)
Dates (From - To)
Approx. No. Miles (Total)
Accident Record
For past 3 years or more (include more if needed in the box provided).
Dates
Nature of Accident
(Head-on, Rear-end, Upset, Etc...)
Number Fatalities/Inuries
Chemical Spills
- Yes
- No
Dates
Nature of Accident
(Head-on, Rear-end, Upset, Etc...)
Number Fatalities/Inuries
Chemical Spills
- Yes
- No
Dates
Nature of Accident
(Head-on, Rear-end, Upset, Etc...)
Number Fatalities/Inuries
Chemical Spills
- Yes
- No
Additional Accident Record Information
Traffic Convictions and Forfeitures
Include all for the past 3 years (other than parking violations).
Date Convicted (MM/YYYY)
Violation
State of Violation
Penalty
(forfeited bond, collateral and/or points)
Date Convicted (MM/YYYY)
Violation
State of Violation
Penalty
(forfeited bond, collateral and/or points)
Date Convicted (MM/YYYY)
Violation
State of Violation
Penalty
(forfeited bond, collateral and/or points)
Additional Traffic Convictions and Forfeitures (Optional)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
- Yes
- No
Please Explain*
Has any license, permit, or privilege ever been suspended or revoked?*
- Yes
- No
Please Explain*
DOT Physical Expiration Date*
MM slash DD slash YYYY

Employment Record
Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).
Current/Last Employer Name*
Current/Last Employer Phone*
Current/Last Employer Address*
Street Address City State ZIP Code
Position Held*
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Salery*
Reasons for Leaving*
Any gaps in employment and/or unemployment must be explained. Include dates (MM/YYYY) and reason
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?*
- Yes
- No
Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 SFR Part 40?*
- Yes
- No
Second Last Employer Name
Second Last Employer Phone
Second Last Employer Address
Street Address City State ZIP Code
Position Held
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Salery
Reasons for Leaving
Any gaps in employment and/or unemployment must be explained. Include dates (MM/YYYY) and reason
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?
- Yes
- No
Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 SFR Part 40?
- Yes
- No
Third Last Employer Name
Third Last Employer Phone
Third Last Employer Address
Street Address City State ZIP Code
Position Held
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Salery
Reasons for Leaving
Any gaps in employment and/or unemployment must be explained. Include dates (MM/YYYY) and reason
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?
- Yes
- No
Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 SFR Part 40?
- Yes
- No
Additional Employers
If you have more than three previous employers to list, please do so in this box. Be sure to list the name, address, phone, position held, from when, to when, salary, reasons for leaving, and any gaps in employment, including dates and reason.
Affidavit
I certify that to the best of my knowledge the information contained in this application is correct. I understand that falsification of application information or material omission may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I understand and agree to the following: 1. My prior employers, educational institutions and other references listed or not listed on this application are authorized to give Hill Meat Company any and all information concerning my previous employment and any pertinent information they may have. I release all persons listed or not listed or entities from all liability for any damage that may result from furnishing information to Hill Meat Company. I also release the Company and all of its employees from all liability for any damage that may result from the Company's reliance on the information furnished. 2. I must produce applicable documents showing that I am lawfully authorized to work in the United States, within the time frame specified by the Company, to meet the Immigration Reform and Control Act of 1986 and amended requirements. 3. The cost of any and all company issued equipment not returned upon termination of employment will be billed to you, as the employee. (Bump caps, time cards, gloves, etc.) 4. Hill Meat Company will not tolerate the abuse of drugs or alcohol in the workplace. Job applicants may be required to pass a pre-employment drug test as a condition of employment. Any employee found to be in possession of illegal drugs or to be under the influence of illegal drugs or alcohol will be subject to termination. Refusal to submit to drug testing may result in disciplinary action, up to and including termination. I agree to submit to drug and alcohol testing upon the reasonable suspicion of the abuse of such substances. If I fail to comply with any of the requirements set forth above, I understand that an offer of employment will be rescinded or my employment will be terminated. In consideration of my employment. I agree to conform to all the Company's policies, rules, and regulations. I understand and agree that my employment with Hill Meat Company is voluntarily entered into and I am free to resign at any time. Similarly, Hill Meat Company being an at-will employer, is free to conclude the employment relationship at any time in which the Company believes is in the Company's best interest. I further understand and agree that this at-will relationship as defined above will remain in effect throughout my employment with Hill Meat Company.
Enter Your Full Name to Agree*
First Middle Last
Agreement Date*
MM slash DD slash YYYY
Applicant Authorization for Reference Checks Including Safety Performance History Concerning Alcohol & Controlled Substances Testing Records
I hereby authorize my past employers to release information to Hill Meat Company regarding my employment. This release of information covers my employment record in general, including information on the following questions: 1. Dates of employment; 2. Position(s) held; 3. The quality and quantity of my work; 4. My attendance habits (excluding workers' compensation, pregnancy, disability FMLA and other protected absences); 5. My relationship with co-workers, supervisors and managers; 6. My attitude toward work (cooperative? positive? ect.); 7. Reason for leaving and eligibility for rehire (would the employer rehire if they had to do it all over again?); 8. Strong and weak points; 9. Willingness to comply with policies and standards; 10. Whether I have had outbursts of temper, threatened, provoked fights with or assaulted others, engaging in hostile or violent behavior; 11. To release and forward the information requested in regards to my safety performance history concerning my Alcohol and Controlled Substances Testing records within the previous 3 years; 12.Other relevant information regarding my performance, skills, ability, suitability for employment sought, etc. I agree that all former employers who provide such information are indemnified and released from liability arising from such disclosures. I also understand that if I do not agree to this Authorization, my application will be rejected. from such disclosures.
Enter Your Full Name to Agree*
First Middle Last
Agreement Date*
MM slash DD slash YYYY

1503 N.W. 50th P.O. Box 1066
Pendleton, OR 97801

541-276-7621
800.929.7621
541.276.9253

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