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General

Date
Location
*Firstname
*Lastname
Middlename
*Social Security Number
*Phone
*Cell
*Date of Birth
*Email
Referred By
Years of Experience
Year of Truck
Date of Last Annual Inspection
CDL#
State
Endorsements
Restrictions
In case of emergency notify
Phone
PAST ALCOHOL AND CONTROLLED SUBSTANCE HISTORY

WORK HISTORY

All applicants must provide all employers during the preceding three years, and up to ten years if driving. List complete address and phone number for each employer. Add additional sheet if necessary. All time must be accounted for including military service, school, self-employment and periods of unemployment NO GAPS!

Any gaps between jobs MUST be explained. Make sure you list each motor carrier, the company that was listed on the side of the truck (not the owner of the truck).

CURRENT OR LAST EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
SECOND TO LAST EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
THIRD TO LAST EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
PRIOR EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
PRIOR EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
PRIOR EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving
PRIOR EMPLOYER
Name
Phone Number
Street Address
City
State
Zip
Position Held
From
To
Reason for Leaving

EDUCATION

Last School Attended
City/State
Truck Driving School
City/State

DRIVING EXPERIENCE

CLASS OF EQUIPMENT TYPE OF EQUIPMENT
 DATES APPROXIMATE
NUMBER OF MILES
(Select all that apply) From To
Straight Truck
Tractor & Semi Trailer
Tractor - Two Trailers
Or
Tractor - Three Trailers
Motor coach - School Bus 15+ Passengers
N/A
Other

ACCIDENT HISTORY (3 years)

DATE TYPE OF ACCIDENT
TOW/HAZMAT SPILL 		FATALITY/INJURY CITATIONS LOCATION AT FAULT?

TRAFFIC CONVICTION and FORFEITURES (last 3 years)

DATE CONVICTED OFFENSE TYPE
(other than parking) 		STATE VEHICLE TYPE

If no violations are listed, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.

Type Name Here

Digital Signature

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.

License Number
State
Expires
If you have more than one license, return to the state issuance. If a license has been lost, stolen, or destroyed, you must notify the state that you no longer want to be licensed by that state.

IF YOUR LICENSE IS SUSPENDED YOU MUST NOTIFY YOUR EMPLOYER THE NEXT BUSINESS DAY.
Part 383 requires that anytime you violate a state or local traffic law, it must be reported within 30 days to your motor carrier and to the state of issuance. These notifications MUST be in writing. Additional licenses previously held:

State
License Number
Endorsements
Restrictions
Expiration Date
I certify that I have read and understood the above requirements:

*Name
*Date

Digital Signature

TRUCKING INDUSTRY

DOT D/A Disclosure and Authorization

Email to: info@vutransportation.com

Help Customer
Company Name: Vu Transportation
Company Contact Name: Kevin Vu
Toll Free: 800-793-0441 x207
apply@vutransportation.com

PART I DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES 49 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING

In accordance with DOT Regulation 49 CFR Part 391.23, I hereby authorize release of my DOT-regulated drug and alcohol testing records by the DOT-regulated employer(s) listed below to Helpe for the purpose Helpe transmitting such records to the Helpe customer listed above. I understand that information/documents released pursuant to this Part I is limited to the following DOT-regulated testing items, including pre-employment testing results, occurring during the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including adulterated and/or substituted tests); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation.

If any company listed below furnishes Helpe with information concerning items (i) through (vi) above, I also authorize such company to furnish the following information to Helpe, if applicable: (i) dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the previous three (3) years; and (ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years.

List all DOT-regulated employers you have applied with and/or worked for in a safety-sensitive function during the previous three (3) years. If necessary, attach additional pages, including the date, your name, social security number and signature.

Previous DOT-Regulated Employer City STATE Phone Number


By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this Part I disclosure and authorization for release; (iii) prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction; (iv) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other lawful purpose; (v) I understand I may review this document with legal counsel prior to signing; and (vi) facsimile or photographic copies of this authorization are as valid as an original.

*Applicant Name
*Social Security#
*Date

Digital Signature

DOT Drug/Alcohol Disclosure/Authorization
Trucking Industry Employment Purpose


CONTRACTOR and/or CONTRACTOR DRIVER APPLICANT CERTIFICATION
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. I hereby understand and acknowledge that unless otherwise defined by applicable law, the specific terms and references contained in the Driver Work History document do not constitute an application for employment with this carrier but, represent a work history record only, for the purpose of driver qualification, as set forth in Part 391 in the FMCSA. This is an independent contractor, not an employee position and without regard to race, color, religion, sex, origin, age, marital status, veteran status, or other protected group status.
My signature also authorizes carrier and any of its agents, contractors, employees to make investigations and inquire about my work, motor vehicle records, medical, financial, credit standing, drug/alcohol history, and any other inquires as well as releasing carrier and all organizations including Hire Right from any and all liability arising out of or related to responding to inquires from carrier and releasing any information in connection with my application.
I recognize that any false information I provide may result in carrier terminating my contracts as on owner operator and /or business relationship. I am certifying that the carrier may also run a DIR report.
My signature also states that I have received, read, and agreed to the Company Policies and Instructions manual and its contents. I understand that I have a right to 1) review information provided by the previous employers, 2) have errors corrected by previous employers, 3) have the previous employer forward corrected information to the prospective employer, and 4) have a rebuttal statement attached to the allegedly erroneous information if the previous employer and I cannot agree on the accuracy. To review information from previous employers submit a written request to Vu Transportation Corp., 12921 Fern St Suite K. Garden Grove, CA 92841 along with a photocopy of your license and social security card within 30 days.

*Name
*Date

Digital Signature

1st Request
2nd Request
3rd Request

Vu Transportation Corp
12921 Fern St Suite K.
Garden Grove, CA 92841
Phone: 800-793-0441
Fax: 800-878-5003

Company
Phone
Fax
Address
MC #
DOT #

The applicant named below has applied to drive for Vu Transportation Corp The applicant listed your company as a past employer

From
To

The applicant has signed a release at the bottom of this form.

Name of Applicant
Social Security
If driver, vehicle type
Number of DOT reportable accidents
Number of preventable accidents
Dates and details of accidents
Details
Additional Remarks

DRUG & ALCOHOL INFORMATION pursuant to 391and 40.25 (drug & alcohol requesting), include any required DOT drug and / or alcohol testing information within the last three years any obtained from previous employers.

If yes, please provide documentation
Signature of person providing information
Date
Print name
Occupation

APPLICANT, PLEASE COMPLETE AND SIGN BELOW:

I *(print name)

authorize the release of this information to Vu Transportation Corp.

*Date

Digital Signature


PREVIOUS EMPLOYER: PLEASE COMPLETE AND Phone: 800-793-0441 or email to apply@vutransportation.com