ROC 1954 Driver’s Application for Employment

Applicant Name

First Last

Hidden

Date of Application

Email

Which Company are you applying for?

ROC INC.

ROC TEXMO LLC.

ROC INC.

1900 W. Sahara Ave.
Las Vegas, NV 89102

Phone: (702) 382-5866

ROC TEXMO LLC.

2950 E Andy Devine Ave,
Kingman, AZ, 86401

Phone: (928) 753-5747

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 REVIEWED & ACKNOWLEDGED BY APPLICANT

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 investigating 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 employers;
· 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.

I agree to the terms

Applicant to Complete (Answer all questions)

Position(s) Applied for:

Name

First Middle Last

Social Security No:

Date of Birth:

Can you provide proof of age?

Yes

No

Do you have the legal right to work in the United States?

Yes

No

List your addresses of residency for the past 3 years.

Current Address

Street Address Address Line 2 City State ZIP Code

How Long?

(yr./mo.)

Please add previous addresses

Previous Address	How long?	Actions
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Have you worked for this company before?

Yes

No

Where?

Position

From:

To:

Reason for leaving:

Rate of pay expected:

Who referred you?

Have you ever been bonded? (answer only if a job requirement):

Yes

No

Name of bonding company:

Can you perform, with or without reasonable accommodation, the essential functions of the job [as described in the attached job description]?

Yes

No

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle¹ in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

Company Name	Address	From:	To:	Actions
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¹ 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.

ACCIDENT REPORT

Have you have been in an accident in the past 3 years or more?

Yes

No

Accident record for the past 3 years or more. If none have occurred, please feel free to skip this section.

Date of Accident:	Nature of accident (head-on, rear-end, upset, etc.):	Injuries:	Fatalities	Hazardous material spill:	Actions
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There are no Entries.

TRAFFIC CONVICTIONS

Have you has any traffic convictions and/or forfeitures (other than parking violations) in the past 3 years?(Required)

Yes

No

Traffic convictions and forfeitures for the past 3 years (other than parking violations). If none have occurred, please feel free to skip this section.

Location	Date	Charge	Penalty	Actions
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EXPERIENCE AND QUALIFICATIONS - DRIVER

Enter any driver licenses or permits held in the past 3 years.

State	License No:	Class	Endorsement(s)	Expiration Date	Actions
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A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

No

IF THE ANSWER TO EITHER A IS YES, GIVE DETAILS:

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

Yes

No

IF THE ANSWER TO EITHER B IS YES, GIVE DETAILS:

DRIVING EXPERIENCE

Please include all classes of equipment you have driven. Please note you can add multiple classes.

Choose Class of Equipment:	If "Other", please list class of equipment:	From:	To:	Approx. no. of miles (total):	Actions
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There are no Entries.

Select all states operated in for the last five years:

Show special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help in your work for this company:

List courses and training other than shown in elsewhere in this application:

List special equipment or technical materials you can work with (other than those already shown):

EDUCATION

Select the highest grade completed.

Elementary/Middle

High School

College

Last school attended:

Address

City State

TO BE READ AND SIGNED BY THE APPLICANT

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.

Time

:

Driver's Application for Employment