Application (Driver/CDL)

* Denotes Required Field Please make sure that you fill out all the required fields before you submit your application.

First Name *	:
Middle Name	:
Last Name *	:
Address *	:
City *	:
State *	:
Zip *	:
Phone (XXX-XXX-XXXX) *	:
Alternate Phone (XXX-XXX-XXXX)	:
The U.S. Department of Transportation requires that driver applicants state their Date of Birth (391.21(b)(2) (MM/DD/YYYY) *	:
If at the above residence less than three years, list all residences for the past three years.	:
Position type *	:	Temporary Part Time Full Time
Position applying for *	:
Who referred you	:
If Coca-Cola employee referred, name of employee	:
If Yes: Dates	:
Have you worked for this company before	:	Yes No
Where	:
Position	:
Hourly rate of pay	:
Reason for leaving	:
Names of any relatives employed by this company	:
Are you currently employed *	:	Yes No
If not, how long since leaving last employment	:
Highest Grade Level Completed *	:	9 10 11 12
Highest College Level Completed	:	1 2 3 4 0
Last school attended (name and address) *	:
Have you ever been bonded *	:	Yes No
If yes, name of bonding company	:
Have you ever been convicted of a felony? *	:	Yes No
If yes, please explain. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.	:
Have you ever worked for this company under another name?	:	Yes No
If yes, under what name?	:
Driver License held in past 3 years (#1): State *	:
Driver License held in past 3 years (#1): License No.*	:
Driver License held in pas 3 years (#1): Class *	:
Driver License held in past 3 years (#1): Endorsement *	:
Driver License held in past 3 years (#1): Expiration Date *	:	1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Driver License held in past 3 years (#2): State	:
Driver License held in past 3 years (#2):License No.	:
Driver License held in past 3 years (#2): Class	:
Driver License held in past 3 years (#2): Endorsement	:
Driver License held in past 3 years (#2): Expiration Date	:
Driver License held in past 3 years (#3): State	:
Driver License held in past 3 years (#3): License No.	:
Driver License held in past 3 years (#3): Class	:
Driver License held in past 3 years (#3): Endorsement	:
Driver License held in past 3 years (#3): Expiration Date	:
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *	:	No Yes
Has any license, permit, or privilege ever been suspended or revoked? *	:	No Yes
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? *	:	No Yes
If you answered "yes" to the above questions, please explain	:
Driving Experience: Class of Equipment	:	Straight Truck Tractor and Semi-Trailer Twin Trailers-LCV's Other
Driving Experience: Type of Equipment (Van, Tank, Flat, etc)	:	Van Tank Flat Other
Driving Experience: Dates (list the dates for each of the equipment you checked)	:
Driving Experiences: Approximate Total Miles (list the miles you drove for each of the equipment you checked)	:
List states operated in during last five years	:
List special courses or training that will help you as a driver	:
List driving awards held and who awards were presented by	:
Accident for past 3 years: Dates (list most recent, then next previous accident dates)	:
Accident for past 3 years: Nature of accident (Head-on, Rear end, Overturn, etc)	:
Accident for past 3 years: Fatalities	:
Accident for past 3 years: Injuries	:
Traffic convictions and forfeitures for past 3 years: Location	:
Traffic convictions and forfeitures for past 3 years: Date	:
Traffic convictions and forfeitures for past 3 years: Charge	:
Traffic convictions and forfeitures for past 3 years: Penalty	:
Present Employer: Name	:
Present Employer: Full Address	:
Present Employer: Zip	:
Present Employer: Phone (XXX-XXX-XXXX)	:
Present Employer: Supervisor's Full Name	:
Present Employer: Position Held	:
Present Employer: Dates of Employment (From MM/DD/YYYY to MM/DD/YYYY)	:
Present Employer: Salary	:
Reason for Leaving	:
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?	:	Yes No
Present Employer: Was this job designated as a "safety sensitive function" in an DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?	:	Yes No
Previous Employer # 1: Name	:
Previous Employer # 1: Full Address	:
Previous Employer 1: Zip	:
Previous Employer # 1: Phone (XXX-XXX-XXXX)	:
Previous Employer # 1: Dates of Employment (From MM/DD/YYY to MM/DD/YYY)	:
Previous Employer #1: Supervisors Full Name	:
Previous Employer #1: Position Held	:
Previous Employer # 1: Salary	:
Previous Employer # 1: Reason For Leaving	:
Previous Employer # 1: Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?	:	No Yes
Previous Employer # 1: Was this job designated as a "safety sensitive function" in an DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?	:	No Yes
Previous Employer # 2: Name	:
Previous Employer # 2: Full Address	:
Previous Employer # 2: Zip	:
Previous Employer # 2: Phone (XXX-XXX-XXXX)	:
Previous Employer # 2: Position Held	:
Previous Employer #2: Supervisor's Full Name	:
Previous Employer # 2:Dates of Employment (From MM/DD/YYY To MM/DD/YYY)	:
Previous Employer # 2: Salary	:
Previous Employer # 2: Reason for Leaving	:
Previous Employer # 2: Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?	:	Yes No
Previous Employer # 2 : Was this job designated as a "safety sensitive function" in an DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?	:	Yes No
List types of platform experience and number of years of each	:
List platform equipment you can operate (lift truck, etc.)	:
Lsit courses or training in platform work	:
Date *	:	1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Please type your name as your electronic signature for this application. By typing your name, you agree to all the terms listed below *	:

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or no, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks, which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination an drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. 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. 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. *** If you have trouble submitting your application, please make sure that you fill out all the required fields and try to submit your application again! ***