DRIVERS APPLICATION

In compliance with Federal and State equal employment opportunity laws, qualified qpplicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, veteran status, non-job related disability, or any other protected group status.

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. (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 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 employer; 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.

APPLICANT TO COMPLETE GENERAL INFORMATION	* - denotes require field
*Position(s) Applied For :
*Name :
*Phone :
Social Security No. :
*License No. :
*Issued :
*Expires :
List your addresses of residency for the past 3 years.
*Current Address :
*City :
*State :
*Zip :
*How Long? (yrs/months)
Previous Address (if less than 2 years) :
City :
State :
Zip :
How Long? (yrs/months)
Do you have the legal right to work in the United States?	Yes No
Date of Birth :
Can you provide proof of age?	Yes No
Have you worked for this company before?	Yes No
*Date From :
*Date To :
*Pay Rate :
*Reason for leaving :
Are you now employed?	Yes No
*If not, how long since last employment?
How did you hear of us?
Rate of pay expected :	$ per
EXPERIENCE & SKILL
License Class	A B C D M
Endorsements	H T P S N
If you do not have an 'H' endorsement can you obtain one?	Yes No
Do you have a valid Federal Medical Card?	Yes No
If 'no,' can you obtain one?	Yes No
CLASS OF EQUIPMENT CIRCLE TYPE OF EQUIPMENT DATES FROM (M/Y) TO (M/Y) NO. OF MILES STRAIGHT TRUCK Yes No Van Tank Flat Dump Refrigerated TRACTOR & SEMI-TRAILER Yes No Van Tank Flat Dump Refrigerated TRACTOR - TWO TRAILERS Yes No Van Tank Flat Dump Refrigerated MOTORCOACH - SCHOOL BUS (16+ Passengers) Yes No Van Tank Flat Dump Refrigerated
SAFETY
Any Traffic Convictions? No Yes Traffic convictions and forfeitures for the past 3 years (Other than parking violations) LOCATION DATE CHARGE PENALTY
Any Accidents? No Yes ACCIDENT RECORD FOR PAST 3 YEARS OR MORE DATE Nature Of Accident (Head On, Rear-End, Upset, Etc.) FATALITIES INJURIES HAZMAT SPILL
Has any license, permit or privilege ever been suspended or revoked?	Yes No
If yes, please explain
LIST ANY SAFE DRIVING AWARDS YOU HOLD AND FROM WHOM
EXPERIENCE & QUALIFICATIONS - OTHER
List special course or training that you have :
List any trucking, transportation or other experience that may help in your work for this company :
List special equipment or technical materials you can work with (other than those already shown) :
Highest Grade Completed (High School) :	1 2 3 4
Highest Grade Completed (College) :	0 1 2 3 4
Last school attended (Name) :
Last school attended (City/State) :
Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?	Yes No
If yes, please explain :
EMPLOYMENT HISTORY
The DOT requires 10 years of employment history
CURRENT OR MOST RECENT CARRIER DATE *Name From To Address Position Held *City *State Zip Number of States *Contact Person *Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States   Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No   CARRIER DATE Name From To Address Position Held City State Zip Number of States Contact Person Phone Salary/Wage Where you subject to the FMCRs while employed? Yes No Reason for Leaving 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? Yes No
*Includes vehicles having a GVWR of 26,001 lbs. Or more, vehicles designed to transport 16 or more passengers, or any size vehicle used to tranposrt 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 lbs or more, (2) is designed or used to transport 8 or more passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
TO BE READ AND ACCEPTED BY APPLICANT By accepting the following, 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 hereby authorize you to release the following information to Sutton Transport, Inc. for purposes of investigation as required by Sections 391.23 and 391.25 of the FMCSR. You are released from any and all liability which may result from furnishing such information."