Application

Today's Date
Today's Date
Hours You Are Applying For *
Date Available to Start *
Date Available to Start
Name *
Name
Current and Past Addresses
For Drivers Only: 10 years of address history is required.
Current Address *
Current Address
FOR DRIVERS ONLY: 10 years of address history is required.
Phone *
Phone
Years/Months
Previous Address #1
Previous Address #1
Years/Months
Previous Address #2
Previous Address #2
Years/Months
Previous Address #3
Previous Address #3
Years/Months
Are you over 21 years of age? *
Date of Birth *
Date of Birth
Do you have legal right to work in the United States? *
If hired, proof of your identity and employment eligibility in the United States must be established by appropriate documentation at the time you begin work at SWD Operating Company, U.C.
Have you worked for this company before? *
Are you employed now? *
Have you ever been convicted of a felony? *
Is there any reason you might be unable to perform the functions of the job for which you have applied? *
Are you willing to work an irregular schedule, overtime, on different shifts, and on weekends when necessary? *
Do you have adequate transportation to travel to and from work? *
Education
How much schooling have you completed? *
Address 4
Address 4
Date Graduated
Date Graduated
Have you ever served in any branch of the U.S. Military? *
Employment History
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List the complete mailing address, street number, city, state, and zip code. Applicants to drive a commercial motor vehicle* in intrastate commerce shall also provide an additional 7 years' information on these employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.)
Employer #1
Address 5
Address 5
Contact Person
Contact Person
Phone 1
Phone 1
Date Worked From
Date Worked From
Date Worked To
Date Worked To
Were you subject to the FMCSRs while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer #2
Address
Address
Contact Person
Contact Person
Phone
Phone
Date Worked From
Date Worked From
Date Worked To
Date Worked To
Were you subject to the FMCSRs while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Vehicle information includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding. The Federal Motor Carrier Safety Regulations (FMCRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle (1) weighs or have a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
Other Experiences or qualifications
Have you had any accidents in the past 3 years? *
Have you had any traffic convictions and/or forfeitures in the past 3 years (other than parking violations)? *
List All Driver Licenses or Permits Held in the Past Three Years
License #1
License #2
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *
Has any license, permit, or privilege ever been suspended or revoked? *
Personal References
Please list three personal references
Please list name, address, and phone number.
Please list name, address, and phone number.
Please list name, address, and phone number.
Certification and Authorization
- PLEASE READ THOROUGHLY - FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title FI, Subtitle D, Chapter 1, of Public law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations. I certify that all facts contained in the application are true and complete and acknowledge that SWD Operating Company, LLC is relying on the accuracy of the information provided. I authorize SWD Operating Company LLC to verify the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to SWD Operating Company, LLC; I also authorize SWD Operating Company LLC to give references and provide information about me in response to inquiries subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in denial of employment or if employed, may result in immediate dismissal. I understand and agree that, if hired; my employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either myself or SED Operating Company, LLC. I also understand and agree that no one has authority to promise me job security or continued employment, except CEO of the company in a formal written agreement signed by both of us.
By typing your name, you verify that you have read and understood the details of this employment application.
Date *
Date