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Driver Application (Step 1 of 5) 3100 Pomona Blvd, Pomona, CA 91768
800-955-4559
Personal Information
Contact Information
*Recruiter:
*Full Name:
*Address 1:
Address 2:
*City:
*State: *Zip:
Reference Name:
Reference Phone: Relationship:
Reference Name:
Reference Phone: Relationship:
*Day Phone: Cell Phone:
Night Phone:
Email: *Best time to call:
*SSN:
*Date of Birth #: *Age:
CDL Information
*Do you have a CDL?  Yes  No *Drivers License Number:
*Issue State: *Expiration Date:
Previous Number: Previous Issue State:
Previous Number: Previous Issue State:
Previous Number: Previous Issue State:
Previous Number: Previous Issue State:
*Check all that apply to your current CDL:
Class A
Class B
Class C
Hazmat
Tanker
Double
Triples
I have a TWIC Card
Can you perform the duties for the job?  Yes  No  
Driver Information
Date Available:
Experience Level:
Education
What is the highest grade you've completed?
Did you graduate from college? Yes  No  
Experience and Preference
Trailer Type Experience and Preference
TRAILER TYPE EXPERIENCE
Flatbed
Van
Tanker
Reefer
Hazmat
Mobile Comm Operations, i.e. Qualcomm, Xata, etc.
Dropdeck
Employment History
Have you ever applied for work and/or worked for this company before? Yes  No  
Current Employer
*Employer name :
*Address Phone
*City *State *Zip
*Start date
*End date
*Position held
Supervisor You may contact this employer
*Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Previous Employer#1
*Employer name :
*Address Phone
*City *State *Zip
*Start date
*End date
*Position held
Supervisor You may contact this employer
Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Previous Employer#2
Employer name:
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Previous Employer#3
Employer name:
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Previous Employer#4
Employer name:
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Previous Employer#5
Employer name:
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven
States/Regions you drove in
No. of accidents/incidents
Add More Previous Employer's
Additional Employment Information
Driving History
Accidents
Accident Record - Include Pending For Past 3 Years Or More
Example: Date, Type, Nature Of Accident, Indicate Preventable, Fatalities, Injuries, Amount Of Property Damage, Vehicle (Head On, Rear End, Upset, Ect.) Or Non-Preventable
Example: Date, Type, Nature Of Accident, Indicate Preventable, Fatalities, Injuries, Amount Of Property Damage, Vehicle (Head On, Rear End, Upset, Ect.) Or Non-Preventable
Example: Date, Type, Nature Of Accident, Indicate Preventable, Fatalities, Injuries, Amount Of Property Damage, Vehicle (Head On, Rear End, Upset, Ect.) Or Non-Preventable
Traffic Convictions
Traffic Convictions and Forfeitures - Include Pending For Past 3 Years
Example: Date, Location, Charge, Penalty
Example: Date, Location, Charge, Penalty
Example: Date, Location, Charge, Penalty
Criminal Record
If hired, can you present evidence of your U.S. Citizenship or proof of your legal right to live and work in this country? Yes  No  
    If so, when...
Have you ever been convicted of a felony? Yes  No
Have you ever been convicted, or are any charges pending; for driving while under the influence, possession, or selling of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes  No
Have you ever used any illegal drug? Yes  No  
Have you ever been convicted of a criminal offense? Yes  No
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes  No
Has any license, permit or privilege ever been suspended or revoked? Yes  No
Have you ever been refused any type of insurance or been denied bonding? Yes  No
Have you ever tested positive or refused a test for drugs or alcohol? Yes  No
Have you ever abandoned your equipment? Yes  No
Have you ever been stopped while intoxicated? Yes  No  
Are you on probation or parole? Yes  No  
Criminal actions pending in which you are out on bail or on your own recognizance pending trial? Yes  No  
** If you answered yes to any of the above, please explain in the comments box below.
Comments
This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I hereby request and authorize KKW Trucking, Inc. and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from various consumer reporting agencies including USIS(DAC) and PSP Reports. Any decision they make not to hire you based on information contained in your consumer report will be their decision alone. DAC does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies themselves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report. Your consent for these companies to obtain the report from DAC is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.
I have read and agree to the above release and I give permission to obtain consumer reports about me from DAC.
Yes  No
  
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