Drivers Application - CNC Oilfield Services LLC

Please select application type: *

In compliance with Federal and State Equal Employment Opportunity Laws, qualified applicants are
considered for all positions without regard to race, color, religion, sex, national origin, age, marital
status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT:

I authorize you to make such investigations and inquiries of my personal, employment, financial or
medical history and other related matters as may be necessary in arriving at an employment decision.
(Generally, inquiries regarding medical history will be made only if and after a conditional offer of
employment has been decided) I hereby release employers, schools, 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 that false or misleading information given in my application
or interview(s) may result in discharge, I understand, also, I am required to abide by all rules and
regulations of the company.
I understand that information I provide regarding current and/or previous employers may be used and those employer(s) will be contacted.
For the purpose of investigation my safety performance history as required by 49 cfr 391.23(d) and (e), I understand that I have the right to:
• Review information provided by previous employer,
• Have errors in the information corrected by previous employers and for those previous employers to
re-send 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.

Signature *

Clear

Date *

APPLICANT GENERAL INFORMATION

Date

First Name *

First

Middle Name *

Middle

Last Name *

Last

Email *

Home Phone *

Mobile Phone

Date Of Birth *

Address *

Address

City

State/Province

Zip/Postal

Have you been at the above address 3 years or longer?

Yes

No

Please provide us with addresses to show the last 3 years of residency.

Address *

Address

City

State/Province

Zip/Postal

How long at this address?

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Would you like to upload a resume?

Yes

No

Attach Resume

Maximum file size: 7.34MB

ADDITIONAL INFORMATION

Have you worked for CNC Oilfield Services before?

Yes

No

Where? *

When? *

Rate of Pay? *

Position Held? *

Reason For Leaving? *

Are You Currently Employed? *

Yes

No

If Not, How Long Since Leaving Last Employment? *

Who Referred You?

Rate Of Pay Expected? *

Have You Ever Been Bonded? *

Yes

No

Name Of Bonding Company? *

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

Yes

No

Violation *

State Of Violation *

Penalty *

If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered:

Is there any reason you might be unable to perform the functions of the job for which you are applying for? *

No

Yes

If Yes, Please Explain.

Do you have vacuum truck experience? *

Yes

No

How Long? (years) *

Do you have guzzler/hydro-vac experience? *

Yes

No

How Long? (years) *

Do you have winch truck experience? *

Yes

No

How Long? (years) *

EMERGENCY CONTACT: Please list an emergency contact that we may reach out to if necessary.

Emergency Contact Name *

Relation *

Emergency Contact Phone Number *

EMPLOYMENT HISTORY- MUST GO BACK 10 YEARS

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 5 years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten years employment record)

You are required to list the complete mailing address, street number and name, city, state and zip code.

Employer Name *

Current Employer?

Yes

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Position Held *

Name Of Last Supervisor *

Start Date *

End Date

Were you subject to FMCSRS** while employed? *

Yes

No

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 *

Yes

No

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Reason For Leaving? (Be Specific)

Was there a time gap between this employment and your last employment? *

Yes

No

If Yes, Please explain the gap in employment. *

*Any gaps in employment and/or unemployment must be explained.
** The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

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Do You Have Any Driving Experience? *

Yes

No

Equipment Experience

Class Of Equipment (Add All That Apply By Using Add Button Below)

From Date:

To Date:

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Have You Had Any Accidents In The Last 3 Years?

Yes

No

Accident Information (List All For Last 3 Years)

Date Of Accident? *

Nature Of Accident? (Head-On, Rear-End, Upset) *

Number Of Fatalities? *

Number Of Injuries? *

Was Hazardous Material Spilled?

Yes

No

Add Another Accident Remove

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 of issue *

Drivers License Number *

Date of expiration? *

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *

Yes

No

If yes, give details: *

Has any license, permit or privilege ever been suspended or revoked?

Yes

No

If yes, give details: *

APPLICATION CERTIFICATION

Please attach the completed authorization form here. *

Maximum file size: 7.34MB

Your digital signature below certifies that this application was completed by you, and that all entries on it and information in it are true and complete to the best of your knowledge.

Signature Of Applicant *

Clear

Date

APPLICANT GENERAL INFORMATION

Please provide us with addresses to show the last 3 years of residency.

ADDITIONAL INFORMATION

EMERGENCY CONTACT: Please list an emergency contact that we may reach out to if necessary.

EMPLOYMENT HISTORY- MUST GO BACK 10 YEARS

Equipment Experience

Accident Information (List All For Last 3 Years)

LICENSE INFORMATION

APPLICATION CERTIFICATION

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