• 5650 6th ST SW  Cedar Rapids,  IA  52404
  • 319-369-4200

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Application for Authorization to Drive

JMS Transportation Co., Inc
5650 6th ST SW
Cedar Rapids,  IA  52404
319-369-4200
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*If at current address less than 5 years, list below most recent addresses for the past 5 years.
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Commercial Drivers License

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CDL Type
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Air Brake Restriction? *
Endorsements (check all that apply)
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Current DOT Medical Card *

Driving/Hauling Experience

Education

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Additional Licenses

Drivers licenses held in the past 5 years must be shown.

Accident Review for Past 4 Years

Last Accident
You must enter all accidents within the last 4 years, regardless of fault. By checking "Yes" you are indicating that you agree and understand that failure to enter an accident that then shows up on your record could be considered falsification of the application. Do you confirm that the accidents you've listed are correct?:*
 

Traffic Convictions & Forfeitures for Past 4 Years

You must enter all traffic convictions and license suspensions for the past 4 years. By checking "Yes" you are indicating that you agree and understand that failure to enter a traffic conviction or forfeiture that shows up on your record could be considered falsification of the application. Do you confirm that the information you have listed is correct?:*
 

Employment History

Begin with your present or most recent job and work backward in order, listing your employers for 10 years (as required by DOT), including all full and part time employment. All times must be accounted for, including military service, self-employment, and periods of unemployment.
EMPLOYER #1
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Driving/Hauling Experience With This Employer
You can add only 15 employers!

Owner Operator Equipment Form

Tractor

Trailer

Straight Truck

Cargo Van

May we contact current employer?           Yes    No

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Authorization

By clicking "Send" below, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, any falsified statements on this application shall be grounds for dismissal. Under the provisions of the Fair Credit Reporting Act, the Americans With Disabilities Act, the Drivers Privacy Protection Act and all other applicable federal, state, and local laws I authorize investigation of all statements contained herein as well as authorize the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise.

I hereby release and hold harmless any person, firm, or entity that discloses information in accordance with this authorization, as well as my prospective employer, and its agents, from any liability that may otherwise result from the request for, use of, or disclosure of, any or all of the foregoing information. The above-mentioned investigations may include, but are not limited to, information as to my character, general reputation, work history, or lifestyle, discerned through employment and education verifications; personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history records; or any other public record.

I understand that consumer reports which may contain public record information may be requested, at the discretion of my prospective employer, which may include names, dates of employment, reason for termination, work experience, traffic records, workers compensation claims, etc. I have the right, under the provisions of the Fair Credit Reporting Act and the Drivers Privacy Protection Act to request all such information from the reporting agency, upon proper identification, and to request the nature and substance of all information; and the receipt of any reports on me, which the reporting agency has, or will, furnish for the two preceding years. I am also entitled to a copy of my consumer rights under the Fair Credit Reporting Act. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.


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This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

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Review your signature

Date: 2018-02-25 13:27:53

Click the Save - but don’t send button if you would like to return and complete your application at a later time. Your work will be saved but will not be sent to the HR Department yet

If you are finished with your application and would like to turn it in please click "Send". Once you Send it you will not be able to make any additional changes.