Application Form

Application For Employment-Qualification
Employment at Hanson Trucking, Inc. and Resin Haulers, Inc. is not guaranteed by submitting this application for employment-qualification.
If you are employed, it will be based on the information that you provide. This information will also be used to determine whether or not
you are qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations
and Hanson Trucking, Inc. Resin Haulers, Inc.

At this time this form will only work if filled out in Internet Explorer.

We are currently testing this form. Should this application result in an interview you may be asked to fill out another application at that time.

Date:

Position Applying For:

Driver Contractor

First & Last Name:

Social Security Number:

Phone:

Emergency Phone:

Date of Birth:* **

Email Address:

Phys Exam Exp Date:

Drivers Lic Exp Date:

* The Age Discrimination of Employment Act of 1967 prohibits discrimination on the
basis of age with respect to individuals who are at least 40 but less than 70 years of age.
** Required as per FMCSRs §391.21 (b)(2).

Current Address:

From:To:

Previous Address:

From:To:

Previous Address:

From:To:

Previous Address:

From:To:

Have you worked for this company before:

Yes
No

If Yes From:To:

Please select highest grade completed.	Grade Schoool	High School	College	Post Grad
Please select highest grade completed.	1 2 3 4 5 6 7 8	9 10 11 12	1 2 3 4	1 2 3 4

Personal References: Please list three persons, other than family members, who have knowledge of your work and safety habits.

Name:	Address:	Phone Number:
Name:	Address:	Phone Number:
Name:	Address:	Phone Number:

Employment History: Give a complete record of any and all employment for the past three years, including any
and all unemployment or self employment and any and all commercial driving experience for the past ten years.

Are you currently working:

Yes
No

If yes, may we contact your current employer:

Yes
No

Present or Last Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

Next Previous Employer:

Name:

From:To:

Address:

Phone Number:

Position Held:

Reason for Leaving:

Were you subject to the FMCSRs* (see explination at bottom of this section) while employed here?

Yes No

Was your job designed as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFR part 40?

Yes No

FMCSR Explanation:
The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor
vehicle on a highway in interstate commerce to transport passengers or property when the vehicle:
(1) has a gross vehicle weight rating (GVWR) or weighs 10,001 pounds or more,
(2) is designed or used to transport more than eight passengers (including the driver), or
(3) is of any size, used to transport hazardous materials in a quantity requiring placarding.

Driving Experience:

Class of Equipment

Dates From and To

Approximate Number of Total Miles

Straight Truck

From:To:

Total Miles:

Tractor and Semi-Trailer

From:To:

Total Miles:

Tractor and Two Trailers

From:To:

Total Miles:

Tractor and Three Trailers

From:To:

Total Miles:

Other

From:To:

Total Miles:

Other

From:To:

Total Miles:

List states operated in for the last 5 years:

List any special courses

or training completed:

Accident Record for Past Three Years:

Date of Accident

Nature of Accident
(Head on, Rear end,
upset, etc.)

Location of Accident

Number of Fatalities

Number of Injuries

Traffic Convictions and Forfeitures for the Last Three Years (other than parking violations):
Date	Location	Charge	Penalty

Driver=s License: List each driver=s license held in the past three years:

State	License #	Type	Endorsements	Exp. Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Yes No
B. Has any license, permit, or priviledge ever been suspended or revoked?	Yes No
C. Is there any reason you might be unable to perform the functions of the job for wich you have applied?	Yes No
D. Have you ever been convicted of a felony? If yes please explain fully below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.	Yes No
E. Are there any circumstances that may prohibit you from hauling into our out of Canada? If yes please explain below.	Yes No
F. Do you have a grandfathering certificate to operate doubles trailers?	Yes No
G. Do you have a grandfathering certificate to operate triples trailers?	Yes No
H. Do you have a certificate of training to operate doubles trailers?	Yes No
I. Do you have a certificate of training to operate triples trailers?	Yes No

If the answers to A, B, C, D, or E is yes, give details below.

This application will only be considered for the job applied for. It will not be considered active after 90 days.
If you desire to be considered for a position at a future time, you must file a new application.

Please use the space provided below for any additional information you wish to provide.

Please add comments here:

By hitting the submit button below it is agreed by the applicant that:

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.
It is agreed and understood that Hanson Trucking, Inc. and Hanson Resin Haulers, Inc. or their agents may investigate my background to ascertain any and all information of concern to my record, whether same is of record or not, and I agree to release current and previous employers and persons named herein from all liability
for any damages on account of his/her furnishing such information.
It is agreed Hanson Trucking Inc. / Resin Haulers Inc. does not guarantee any information that is transmitted over the Internet, however once Hanson Trucking is in possession of your information it will not be given to any third parties.