Brannan Paving Co., Ltd.
DRIVER'S APPLICATION FOR EMPLOYMENT
It is the policy of Brannan Paving Co. Ltd., to assure that applicants are employed, and that
employees and applicants for employment are treated fairly and to provide equal employment
opportunity to all employees and applicants for employment and not to discriminate on any basis
prohibited by law, including race, color, sex, age, religion, national origin, disability, age, sexual
orientation, gender or gender conformity, marital status or veteran status. Such action shall
include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising;
layoff or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship, pre-apprenticeship, and/or on-the-job training.
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. (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 further understand that if I am employed, it will be
"AT WILL", subject to termination at any time by either party, with or without notice.
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 [including ACCIDENT INFORMATION AND DRUG/ALCOHOL TESTING INFORMATION] as required by Federal Motor Carrier laws. 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 employers; and
- 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.
List your addresses for the past 3 years.
IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS
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 interstate or intrastate commerce shall also provide an
additional 7 years' information on those employers for whom the applicant operated such vehicle(s).
NOTE: List employers in reverse order stating with the most recent; add another sheet if necessary.
(Start with your present or most recent position. Use an additional sheet of paper if more space is needed).
Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more
passengers (including driver) of any size vehicle used to transport hazardous materials in a quantity requiring placarding.
**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
driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
IMPORTANT, PLEASE READ AND SIGN: I understand that failure to reveal any prior employer,
or giving false or misleading information by me on any part of this Application for Employment can
be grounds for termination from the company. I understand that if I am employed, my employment
is "AT WILL" and is for no definite time and may be terminated by the company or me at any time
without prior notice.