DRIVER'S APPLICATION FOR EMPLOYMENT
Name and Address
Full Legal Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
How Long at this Address
Date of Birth*
MM slash DD slash YYYY
Social Security #*
Cell Phone
Cell Phone Provider
Email*
Enter Email Confirm Email
Have you worked for VIP previously?*
- Yes
- No
When did you leave and why?*
Please list below your general hours of availability each day of the week:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Driver's License No.*
Issuing State*
License Expiration Date
MM slash DD slash YYYY
Do you hold a current DOT Medical Card?*
- Yes
- No
Do you currently hold a commercial driver’s license (CDL)?*
- Yes
- No
Do you currently have passenger endorsement on your CDL?*
- Yes
- No
Have you ever been denied a license, permit or privelege to operate a motor vehicle?*
- Yes
- No
Explain Denial*
Has any license, permit or privelege ever been suspended or revoked?*
- Yes
- No
Explain suspension/revocation and list dates:*
Have you ever been terminated from a job?*
- Yes
- No
Please provide a detailed explanation for the termination:*
Have you ever been terminated or suspended for failing a drug or alcohol screen?*
- Yes
- No
Please provide a detailed explanation for the termination or suspension:*
Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer in the last 2 years?*
- Yes
- No
Have you ever been arrested?*
- Yes
- No
Please provide detailed information regarding the arrest:*
Have you ever been convicted of a felony?*
- Yes
- No
Please provide a detailed explanation for the conviction:*
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 READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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 understand, also, that I am required to abide by all rules and regulations of the Company.
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 erroneious information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Date
MM slash DD slash YYYY
Signature

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Previous Three Years Residency
#1
Street Address City State ZIP Code
Residence From:
MM slash DD slash YYYY
Until:
MM slash DD slash YYYY
#2
Street Address City State ZIP Code
Residence From:
MM slash DD slash YYYY
Until:
MM slash DD slash YYYY
#3
Street Address City State ZIP Code
Residence From:
MM slash DD slash YYYY
Until:
MM slash DD slash YYYY
Driving Experience
Please Click the + sign to add more experience. You may enter the full Dates of Experience (month and year) OR the Approximate # of Miles, but both are not required.
Tractor and Semi-Trailer
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Tractor-Two Trailers
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Straight Truck
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Motorcoach - School Bus (more than 8 passengers)
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Motorcoach - School Bus (More than 15 passengers
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Other
Type of Equipment (Van, Tank, Flat, etc.) Dates (M/Y to M/Y) Approx # of Miles (Total)
Accident Record for Past 3 Years or More
Were You Accident Free for the last 3 years?*
- Yes
- No
Accident History*
Dates Nature of Accident (Head-On, Rear-End, Upset, Etc.) # Fatalities # Injuries Chemical Spills (Y or N)
Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)
Did you have any Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)*
- Yes
- No
Convictions*
Date Convicted Violation State of Violation Location Penalty (Forfeited bond, collateral and/or points

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VIP Limo Employment Application

Step 1 of 3 - Name & Address

DRIVER'S APPLICATION FOR EMPLOYMENT

Name and Address

TO BE READ AND SIGNED BY APPLICANT

Previous Three Years Residency

Driving Experience

Accident Record for Past 3 Years or More

Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)

Employment Record

Minimum of 3 years history required for all applicants; Minimum of 10 years history for CDL applicants. Please outline any gaps in employment in the available sections.

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Type of Equipment (Van, Tank, Flat, etc.)	Dates (M/Y to M/Y)	Approx # of Miles (Total)

Type of Equipment (Van, Tank, Flat, etc.)	Dates (M/Y to M/Y)	Approx # of Miles (Total)

Type of Equipment (Van, Tank, Flat, etc.)	Dates (M/Y to M/Y)	Approx # of Miles (Total)

Type of Equipment (Van, Tank, Flat, etc.)	Dates (M/Y to M/Y)	Approx # of Miles (Total)