Fuel Driver | Weaver Bros., Inc.

Job Description:

Union Application Form

Step 1 of 6

Your Personal Information
Your Name(Required)
First Middle Last
Your Email Address
Enter Email Confirm Email

Address
Street Address Address Line 2 City State ZIP Code

Home Phone
Cell Phone
Best Time To Call You
Birthdate(Required)
The U.S. Dept. of Transportation requires that driver applicants state their date of birth. Part 391.21(b)(2)
Hidden
Social Security #

Have you ever applied to/worked for WBI?

Yes

No
Do you have any friends, relatives, or acquaintances working for WBI?

Yes

No
If yes, who/relationship

Position You're Applying For
Position Applying For(Required)
Check all that apply:
Line Haul
Fuel
Hostler
Winch Truck
Mechanic
Salary Desired (Be Specific)

Who Referred You?

Are You Willing To Relocate?

Yes

No
If Yes, Where?
Anchorage
Fairbanks
Kenai
Are You Currently Employed?

Yes

No
If Not, How Long Since Last Employed?

Employment Desired

Full-Time Only

Part-Time Only

Full or Part-Time

Other
When available for work?

Educational Background
Highest Grade Completed
College
Last School Attended (Name And Address)

General
Have you ever been convicted of a crime?(Required)

Yes

No
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
Driver Licenses Held In The Past 3 Years Must Be Listed. Click The + Sign To Add More Entries:
State
License #
Type
Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

No
B. Do you have a pending charge or past conviction for driving while intoxicated?

Yes

No
C. Has any license, permit or privilege ever been suspended or revoked?

Yes

No
D. Do you have a pending charge or past conviction for possession of a controlled substance?

Yes

No
E. Have you ever been refused liability insurance?

Yes

No
F. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

Yes

No
If you answered “YES” to A, B, C, D, E, or F, please state details below:
List States Operated In The Last 5 Years

List Special Courses Or Training That Will Help You As A Driver

List Safe Driving Awards Received And From Whom

Accident Review
Please List All Accidents Starting From Most Recent. Click The + Sign To Add More Entries.
Type (Head-On, Rear End, Etc.)
City And State
# Fatalities
# Injuries
Was Hazmat Released?

Please Enter Any Additional Details Below Regarding Accidents:
Traffic Convictions & Forfeitures. Click The + Sign To Add More Entries.
For the past 3 years other than parking violations. Click the + sign to add more entries.
Location
Date
Charge
Penalty

Employment Record
The U. S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July 1987 they must also show commercial driver employment for the seven years immediately preceding this three year period. Part 391.21 (b)(10),(11).
THIS FORM MUST BE COMPLETE EVEN IF YOU SUBMIT A RESUME!!!

Start with last or current position, including military experience, and work back. Please provide 10 years of work history.

Safety-sensitive function means all time from the time a driver begins to work or is required to be in readiness to work until the time he/she is relieved from work and all responsibility for performing work. Safety-sensitive functions shall include:

(1) All time at an employer or shipper plant, terminal, facility, or other property, or on any public property, waiting to be dispatched, unless the driver has been relieved from duty by the employer;

(2) All time inspecting equipment as required by §§392.7 and 392.8 of this subchapter or otherwise inspecting, servicing, or conditioning any commercial motor vehicle at any time;

(3) All time spent at the driving controls of a commercial motor vehicle in operation;

(4) All time, other than driving time, in or upon any commercial motor vehicle except time spent resting in a sleeper berth (a berth conforming to the requirements of §393.76 of this subchapter);

(5) All time loading or unloading a vehicle, supervising, or assisting in the loading or unloading, attending a vehicle being loaded or unloaded, remaining in readiness to operate the vehicle, or in giving or receiving receipts for shipments loaded or unloaded; and

(6) All time repairing, obtaining assistance, or remaining in attendance upon a disabled vehicle.

May We Contact Your Current Employer?

Yes

No
Current Employer
Current Employer

Supervisor's Name

Address
Street Address City State / Province / Region ZIP / Postal Code Country

From
To
Position Held

Phone
Reason For Leaving

Were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No
Was the Job designated as a “safety sensitive function” in any DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?

Yes

No
Previoius Employer
Previous Employer

Supervisor's Name

Address
Street Address City State / Province / Region ZIP / Postal Code Country

From
To
Position Held

Phone
Reason For Leaving

Were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No
Was the Job designated as a “safety sensitive function” in any DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?

Yes

No
Previoius Employer
Previous Employer

Supervisor's Name

Address
Street Address City State / Province / Region ZIP / Postal Code Country

From
To
Position Held

Phone
Reason For Leaving

Were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No
Was the Job designated as a “safety sensitive function” in any DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?

Yes

No
Previoius Employer
Previous Employer

Supervisor's Name

Address
Street Address City State / Province / Region ZIP / Postal Code Country

From
To
Position Held

Phone
Reason For Leaving

Were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No
Was the Job designated as a “safety sensitive function” in any DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?

Yes

No
Previoius Employer
Previous Employer

Supervisor's Name

Address
Street Address City State / Province / Region ZIP / Postal Code Country

From
To
Position Held

Phone
Reason For Leaving

Were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No
Was the Job designated as a “safety sensitive function” in any DOT-regulated mode subject to alcohol and drug testing requirements as required by 49 CFR Part 40?

Yes

No

Maintenance/Office Experience And Qualifications
Please select how many years of experience you have on each item
Body Work
Air Conditioning
Diesel Engine Tune-up/Rebuild
Drive Line Components
Gas Engine Tune-up/Rebuild
Tire Service
Trailer Repair
Brakes
Cooling Systems
Electrical Repair
Frame/Wheel Alignment
General Car Repair
Inspections
Other:

Shop Equipment
Diesel Injection Equipment
Electric Welder
Electrical Diagnostic Equipment
Engine Rebuilding Equipment
Frame/Axle Straightening Equip
General Car Repair
Oxyacetylene Welder
Paint Spray Gun
Sheet Metal Equipment
Engine Analyzer
Engine Dynamometer
Inspections
Magnetic Crack Detector
Noise Measuring Equipment
Smoke Measuring Equipment
Tire Recapping Mold
Tire Servicing Machine
Wheel/Tire Balancing Mach
Clerical Experience And Qualifications
Accounting
Billing
Calculator / 10-key
Cashier
Claims
Computers
Database
Dictation
Dispatcher
Fax
Filing
Multi-line telephone system
OS & D
PDA’s
Photocopier
Pricing
Rates
Sales
Shorthand
Spreadsheets
Typing
Word Processing
Equipment Experience
Tractor - Containers

Yes

No
From
To
Approximate Number Of Miles

Tractor - Doubles/Triples

Yes

No
From
To
Approximate Number Of Miles

Tractor - Dry Bulkers

Yes

No
From
To
Approximate Number Of Miles

Tractor - Vans

Yes

No
From
To
Approximate Number Of Miles

Tractor - Flatbeds

Yes

No
From
To
Approximate Number Of Miles

Tractor - Lowboys

Yes

No
From
To
Approximate Number Of Miles

Tractor - Reefer Vans

Yes

No
From
To
Approximate Number Of Miles

Tractor - Tanker

Yes

No
From
To
Approximate Number Of Miles

Straight Truck

Yes

No
From
To
Approximate Number Of Miles

Winch Truck

Yes

No
From
To
Approximate Number Of Miles

Truck / Pup

Yes

No
From
To
Approximate Number Of Miles

Haul Road

Yes

No
From
To
Approximate Number Of Miles

Other:

Please Select If You Have Experience With:
Chains and binders
Fork Lift
Front End Loader
Fuel Delivery
Hazardous Materials
Heavy Haul Loads
Load Locks
Lumber and Tarps
Over-Dimensional Cargo
Permit Ordering
Reefer Units
Route Planning
Straps
Use of Coil Racks
Others: Please Describe

Please Select If You Ever Hauled:
Bulk Cement
Chemicals
Fuel
Groceries
Heavy Equipment
Hot Oil
Lumber
Machinery
Plastic Pipe
Steel or Concrete Beams
Steel Pipe
Vehicles
Others: Please Describe

List Any Information That You Feel Wold Be Meaningful:
Please Read Carefully
Applicant Must Read And Sign(Required)
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 not, 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 and drug test. If you agree that the employer may obtain background reports, please read the following and sign below.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, 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 examination as may be required to complete my employment file.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I also understand that misrepresentation of 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.

I understand that the Employer is required to do a safety performance history investigation with those employers where I was subject to the Federal Motor Carriers Safety Regulations within the last three years. This investigation will include general identification and employment information, accident information, and drug/alcohol testing information.

I also am aware of the following due process rights and that I have the right to:

1. Review information provided by previous employers;
2. Have errors in the information corrected by the previous employer, and for that previous employer to re-send the corrected information to the prospective employer;
3. Have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Employment is subject to:
1. Passing physical exam by company designated physician 2. Satisfactory background and reference reports 3. Favorable reports from outside agencies and organizations on verification of information supplied 4. Successful completion of job skills test(s) (if required)
I hereby authorize the Employer and its employees, agents, and affiliates to obtain any and all of the information authorized above. Also, please sign by typing your name below.
Type In Your Name To Sign(Required)

Date(Required)
Please Read Carefully
Important Notice Regarding Background Reports From The PSP Online Service(Required)
In connection with your application for employment with Weaver Bros., Inc., it may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If Weaver Bros., Inc. uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, Weaver Bros., Inc. will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, Weaver Bros., Inc. will notify you that the action has been taken and that the action was based in part or in whole on this report. Weaver Bros., Inc. cannot obtain background reports from FMCSA unless you consent in writing. If you agree that Weaver Bros., Inc. may obtain such background reports, please read the following and sign below:

I authorize Weaver Bros., Inc. to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist Weaver Bros., Inc. to make a determination regarding my suitability as an employee.

I further understand that neither Weaver Bros.Inc. nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

I have read the above Notice Regarding Background Reports provided to me by Weaver Bros., Inc. and I understand that if I sign this consent form, Weaver Bros., Inc. may obtain a report of my crash and inspection history. I hereby authorize Weaver Bros., Inc. and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Also, please sign by typing your name below.
Type In Your Name To Sign(Required)

Date(Required)

Equal Employment Opportunity (EEO) Self Identification Form
Qualified applicants are considered for employment without regard to race, religion, sex, national origin, age, marital status, sexual orientation, veteran status, disability, or other protected characteristic. This form will be kept in a confidential file separate from any application files or personnel records. The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites applicants and employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Name
First Middle Last
Address
Same as previous

Street Address Address Line 2 City State ZIP Code

Gender Identification (Check One) Sex:

Male

Female
Race/Ethnic Identification (Check One)

Hispanic or Latino

White

Black of African American

Native Hawaiian or Other Pacific Islander

Asian

American Indian or Alaskan Native

Two or More Races

Decline Self-Identification
Veteran?

Yes

No
If yes, which era?

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