Mark Wright Driver’s Employment Application

  • Date Format: MM slash DD slash YYYY
  • Previous Three Years Residency
  • Street, city, state, zip
  • Street, city, state, zip
  • Street, city, state, zip
  • LICENSE INFORMATION
    Section 382.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do no have more than one motor vehicle license, the information for which is listed below.
  • Date Format: MM slash DD slash YYYY
  • Driving Experience
  • Type of Equipment (van, tank, flat, etc)
  • From-To
  • Approximate Number of Miles (total)
  • Type of Equipment (van, tank, flat, etc)
  • From-To
  • Approximate Number of Miles (total)
  • Type of Equipment (van, tank, flat, etc)
  • From-To
  • Approximate Number of Miles (total)
  • ACCIDENT RECORD for the past three years (other than parking violations)
  • (month/year)
  • (forfeited bond, collateral and/or points)
  • (month/year)
  • (forfeited bond, collateral and/or points)
  • (month/year)
  • (forfeited bond, collateral and/or points)
  • Date Format: MM slash DD slash YYYY
  • Education

  • Employment

    List your three most recent employers with their addresses and phone numbers, starting with the most recent first.

    Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same informaiton for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).
  • Non-Office Position Questions

  • By signing this application, I am granting permission for you to conduct a three-year driver's license check and criminal background check during this pre-employment state and (if hired) during employment, at the discretion of the employer. I hereby state that all of the preceding information in this application is accurate and true to the best of my knowledge and attest to this by my signature following:
  • I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary for 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 regulation 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 current/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 erroneous information, if the previous employers(s) and I cannot agree on the accuracy of the information.
  • Sign this application by entering your full name above.
  • 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.
  • Sign this application by entering your full name above.
  • A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.
  • Equal Opportunity Employer
    Mark Wright Disposal provides the opportunity for an individual to secure employment without discrimination because of race, color, sex, sexual orientation, physical or mental disability, religion, age, ancestry or national origin is recognized as and declared to be a civil right. [2005, c.10, § 10 (AMD).]