TRUCK DRIVER ONLY APPLICATON

(Equal Opportunity Employer)

Plains Ag, LLC (herein after referred to as “The Company”) is an Equal Opportunity Employer. The Company will not discriminate with respect to employment selection, compensation, training, termination, conditions, terms, or privileges of employment because of an individual’s race, color, religion, sex, national origin, age, handicap, or on any other basis prohibited by applicable law. Accordingly, it will not make employment decisions for any reasons that do not represent a bona fide occupational qualification.

Please fill in all required fields.

Truck Driver Only Application

Date of Application
Store Location
Last Name
First Name
Middle Name
Home Phone
Cell
Email
Address
City
State
Zip
How long have you resided at this address?
Referral Source
Date Available for Employment
Are you available to work

If you have lived at your current address for less than 3 years, please list your address of residency from the past 3 years

Previous Addresses

Street
City
State
Zip
Phone
How Long?
Street
City
State
Zip
Phone
How Long?
Street
City
State
Zip
Phone
How Long

If applying for a position where driving is required, you must meet our insurance company's requirements.
(Driver’s License information will be submitted for determination of insurability, we will contact you for the driver's license number.)

Do you have a valid drivers license?
Name on License
Type
State
Expiration date of license
Do you have more than one license that is currently valid?
Name On License
Type
State
Expiration date of license
Have you ever been denied a license or had your license suspended?
If yes, please provide an explanation
If employed and under 18, can you furnish a work permit?
Do you have the legal right to work in the United States?
Have you worked for this company before?

If yes, please specify below

Date From
Date To
Position
Location
Reason for leaving
Are you currently employed
If not, how long since leaving last employment?
May we contact your present employer?
If yes, give name
Rate of pay expected
Is there any reason you might be unable to perform the essential functions of the job for which you have applied [as described in the job description]?
If yes, please explaing if you wish
Have you been convicted of a felony?

(Please note that a “yes” will not bar you from consideration for employment.)

If yes, please explain

Employment History

PLEASE NOTE: All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle.

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

(NOTE: List employers in reverse order starting with the most recent.)

Employer
Address
City
State
Zip
Supervisor's Name
Phone Number
May we contact?
Employed From
Position Held
Duties
What do you like most about your job?
Reason for leaving?
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40?
**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
Employer
Address
City
State
Zip
Supervisor's Name
Phone Number
May we contact?
Employed From
Employed To
Position Held
Duties
What do you like most about your job?
Reason for leaving?
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40?
Employer
Address
City
State
Zip
Supervisor's Name
Phone Number
May we contact?
Employed From
Employed To
Position Held
Duties
What do you like most about your job?
Reason for leaving?
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40?
Employer
Address
City
State
Zip
Supervisor's Name
Phone Number
May we contact?
Employed From
Employed To
Position Held
Duties
What do you like most about your job?
Reason for leaving?
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR PART 40?

Education

High School

Name
Address
Highest Grade Completed

College

Name
Address
Years Completed
Course of Study

Graduate School

Name
Address
Years Completed
Course of Study

Special skills, qualifications and considerations

Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking:

References

List three (3) non-relatives who are familiar with your qualifications, work history and ability.

Name
Occupation
Years Known
Phone Number
Name
Occupation
Years Known
Phone Number
Name
Occupation
Years Known
Phone Number
Name
Occupation
Years Known
Phone Number
Please list violations of motor vehicle laws in last three (3) years. (Include approximate date and violation)
Please list any motor vehicle accidents in the last three (3) years and include the date of accident.

Driving Experience

Class of Equipment

Type of Equipment

Dates

Approx. Number of Miles

Straight Truck
Straight Truck Type
From (M/Y)
To (M/Y)
Total Miles
Tractor & Semi-Trailer
Tractor & Semi-Trailer Type
From (M/Y)
To (M/Y)
Total Miles
Tractor-Two Trailers
Tractor-Two Trailers Type
From (M/Y)
To (M/Y)
Total Miles
Tractor-Three Trailers
Tractor-Three Trailers Type
From (M/Y)
To (M/Y)
Total Miles
Motorcoach-School Bus (8+ Passenger)
Motorcoach-School Bus (8+ Passenger) Type
From (M/Y)
To (M/Y)
Total Miles
Motorcoach-School Bus (15+ Passenger)
Motorcoach-School Bus (15+ Passenger) Type
From (M/Y)
To (M/Y)
Total Miles

THIS SECTION IS REQUIRED TO BE COMPLETED BY ANYONE WHO WILL DRIVE A MOTOR VEHICLE RATED OVER 10,001 LBS.

Date of Birth

(DOB is required for anyone who will be driving a motor vehicle rated over 10,001 lbs.)

List states operated in for last five years
Show special courses or training that will help you as a driver
Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help in your work for this company
List courses and training other than shown elsewhere in this application
List special equipment or technical materials you can work with (other than those already shown)

TO BE READ AND SIGNED BY APPLICANT WHO WILL DRIVE A MOTOR VEHICLE RATED OVER 10,001 LBS.

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: (1) Review information provided by previous employers, (2) 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 (3) 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.

Signature
Date

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING.

I certify that all answers and statements I have made on this Application (and resume or other supplementary materials) are true and complete without omissions. By signing below, I authorize THE COMPANY to investigate all statements contained in this Employment Application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this Application to give you complete information and records regarding my employment, education, character and qualifications.

If hired, I will be responsible for familiarizing myself with all rules, regulations and policies of THE COMPANY as they presently exist or are later modified. If hired, I understand my employment can be terminated, at the discretion of THE COMPANY or at my option, without notice, at any time and for any reason.

I also understand that no representative of THE COMPANY has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the president of THE COMPANY.

I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.

By selecting the
Signature of Applicant
Date

For security purposes, please complete the verification pictures.