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Driver Employment Application

  1. HR Logo - NEW
  2. DRIVER EMPLOYMENT APPLICATION

    Town of Castle Rock

    100 N Wilcox St., Castle Rock CO 80104 

    Phone Number: 720-733-2218, Email: hr@crgov.com

    An Equal Opportunity Employer

  3. **Please note, if you do not currently hold a CDL, but will obtain one per your job description requirements, please fill out all the fields with the exception of "Driving Experience".**

  4. APPLICANT INFORMATION
  5. Do you have legal right to work in the United States?*
  6. PREVIOUS THREE YEARS RESIDENCY

    Attach additional sheets if more space is needed. To upload additional sheets, please see section below titled "Attach additional information" to upload.

  7. CURRENT ADDRESS

  8. MAILING ADDRESS (if different from current address)

  9. PREVIOUS ADDRESS

  10. LICENSE INFORMATION

    No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed. To upload additional sheets, please see section below titled "Attach additional information" to upload.

  11. CURRENT LICENSE

  12. PREVIOUSLY HELD LICENSE

  13. PREVIOUSLY HELD LICENSE

  14. DRIVING EXPERIENCE
  15. CLASS OF EQUIPMENT - STRAIGHT TRUCK
  16. (van, tank, flat, etc.)

  17. CLASS OF EQUIPMENT - TRACTOR & SEMI-TRAILER
  18. (van, tank, flat, etc.)

  19. CLASS OF EQUIPMENT - TRACTOR & 2 TRAILERS
  20. (van, tank, flat, etc.)

  21. CLASS OF EQUIPMENT - TRACTOR & TANKER
  22. (van, tank, flat, etc.)

  23. CLASS OF EQUIPMENT - OTHER
  24. (van, tank, flat, etc.)

  25. ACCIDENT RECORD FOR THE PAST THREE YEARS

    Attach additional sheets if more space is needed. To upload additional sheets, please see section below titled "Attach additional information" to upload.

  26. Check this box if none.
  27. (list most recent first)

  28. (Head-on, rear-end, upset, etc.)

  29. CHEMICAL SPILL?
  30. (Head-on, rear-end, upset, etc.)

  31. CHEMICAL SPILL?
  32.  (Head-on, rear-end, upset, etc.)

  33. CHEMICAL SPILL?
  34. TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST THREE YEARS (other than parking violations)

    Attach additional sheets if more space is needed. To upload additional sheets, please see section below titled "Attach additional information" to upload.

  35. Check is this box if none.
  36. (Month/Year)

  37. (Forfeited bond, collateral and/or points)

  38. (Month/Year)

  39. (Forfeited bond, collateral and/or points)

  40. (Month/Year)

  41. (Forfeited bond, collateral and/or points)

  42. If yes, explain

  43. Yes or No
  44. If yes, explain

  45. Yes or no
  46. EMPLOYMENT HISTORY

    The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

    Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). To upload additional sheets, please see section below titled "Attach additional information" to upload.You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

  47. CURRENT (MOST RECENT) EMPLOYER
  48. (Include month/year & reason)

  49. While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
  50. Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
  51. SECOND MOST RECENT EMPLOYER
  52. (Include month/year & reason)

  53. While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
  54. Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
  55. THIRD MOST RECENT EMPLOYER
  56. (Include month/year & reason)

  57. While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
  58. Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
  59. EDUCATION
  60. HIGH SCHOOL
  61. Graduate?
  62. COLLEGE - UNIVERSITY
  63. Graduate?
  64. OTHER
  65. Graduate
  66. OTHER QUALIFICATIONS
  67. TO BE READ AND SIGNED BY APPLICANT
  68. I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

    I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:

    • Review information provided by current/previous employers;

    • Have errors in the information corrected by previous employers, and for those previous employers to resend 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.

    This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.


  69. Typing your name above constitutes a legal signature whereby you are confirming the information provided in this form is true and correct to the best of your knowledge.

  70. WE RECOMMEND YOU INCLUDE YOUR EMAIL ADDRESS TO RECEIVE A COPY OF THIS APPLICATION.

    BE SURE TO HIT THE SUBMIT BUTTON.

  71. Leave This Blank:

  72. This field is not part of the form submission.