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Drivers’ Employment Application

Name(Required)

First Last

Company

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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

To Be Read and Acknowledged by Applicant

To be read and signed by applicant

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purposes of investigating my safety performance history as required by 49 CFR 391.23(d) and (3). 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 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.

Signature(Required)

I Certify that I Acknowledge and Understand This Statement

Termination of Employment

Date Terminated

MM slash DD slash YYYY

Department Released From

Supervisor

Dismissal Details

Dismissed

Voluntarily Quit

Other (please specify)

Termination Report Placed in File

Yes

No

Other (Please Specify)

Applicant to Complete

Position(s) Applied For:

Name

First Middle Last

Social Security Number

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long? (yr./mo.)

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long? (yr./mo.)

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long? (yr./mo.)

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long? (yr./mo.)

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long? (yr./mo.)

Do you have the legal authority to work in the United States?

Yes

No

Date of Birth (Required for Commercial Drivers)(Required)

MM slash DD slash YYYY

Have you previously worked for Nampa Paving or previously applied for work with Nampa Paving?(Required)

Yes

No

Where?

Dates (From):

MM slash DD slash YYYY

Dates (To):

MM slash DD slash YYYY

Reason for Leaving:

Who referred you?

Rate of pay expected:

Have you ever been bonded?

Name of Bonding Company

Can you perform, with or without reasonable accomodation, the essential functions of the job (as described in the job description)?(Required)

Yes

No

Employment History

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

Latest Employer

Address

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

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Contact Person

Phone Number

Position Held

Reason for Leaving

Were you subject to the FMCSRs** while employed?

Yes

No

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

Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Contact Person

Phone Number

Position Held

Reason for Leaving

Were you subject to the FMCSRs while employed?

Yes

No

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

Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Contact Person

Phone Number

Position Held

Reason for Leaving

Were you subject to the FMCSRs while employed?

Yes

No

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

Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Contact Person

Phone Number

Position Held

Reason for Leaving

Were you subject to the FMCSRs while employed?

Yes

No

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 (including the driver), or 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 the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record for Past 3 Years or More (Attach Sheet if More Space is Needed)

Accident Record

No accident record

Accident Record (Info Below)

Last Accident Date

MM slash DD slash YYYY

Nature of Accident (head-on, rear end, upset, etc.)

Fatalities

Injuries

Hazardous Material Spill

I have more accidents to report

Yes

No

Next Previous Accident Date

MM slash DD slash YYYY

Nature of Accident (head-on, rear end, upset, etc.)

Fatalities

Injuries

Hazardous Material Spill

Next Previous Accident Date

MM slash DD slash YYYY

Nature of Accident (head-on, rear end, upset, etc.)

Fatalities

Injuries

Hazardous Material Spill

Traffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)

If None, Mark None

None

I have traffic convictions and/or forfeitures to report

Location

Date

MM slash DD slash YYYY

Charge

Penalty

Location

Date

MM slash DD slash YYYY

Charge

Penalty

Location

Date

MM slash DD slash YYYY

Charge

Penalty

Experience and Qualifications - Driver

Driver licenses or permits in the past 3 years.

Issuer

License No.

Class

Endorsements

Expiration Date

MM slash DD slash YYYY

Issuer

License No.

Class

Endorsements

Expiration Date

MM slash DD slash YYYY

Issuer

License No.

Class

Endorsements

Expiration Date

MM slash DD slash YYYY

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

Yes

No

Has any license, permit or privilege ever been suspended or revoked?

Yes

No

If the answer to either of the above is yes, please provide details here.

Driving Experience

Check if if you have driven the following class of equipment

Straight Truck

Tractor and Semi-Trailer

Tractor - Two Trailers

Tractor - Three Trailers

Motorcoach - School bus (More than 8 Passengers)

Motorcoach - School bus (More than 15 Passengers)

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Equipment Type

Van

Tank

Flat

Dump

Refer

Approx Number of Miles (Total)

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Equipment Type

Van

Tank

Flat

Dump

Refer

Approx Number of Miles (Total)

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Equipment Type

Van

Tank

Flat

Dump

Refer

Approx Number of Miles (Total)

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Equipment Type

Van

Tank

Flat

Dump

Refer

Approx Number of Miles (Total)

List States Operated in for Last 5 Years:

List Special Courses or Training that will Help You as a Driver

Which Safe Driving Awards do you Hold and From Whom?

List 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)

Education

Highest Grade Completed (Elementary)

Highest Grade Completed (High School)

Highest Grade Completed (College)

Last School Attended

City & State

I certify 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.(Required)

I certify 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.

Email

This field is for validation purposes and should be left unchanged.

About Us

Established in Nampa, Idaho in 1983, the Wood family has built Nampa Paving from the ground up. It remains a family owned and operated company who believes that hard work and honesty is the key to success.

© 2024 Nampa Paving, Inc. | All Rights Reserved

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Nampa Paving

444 W Karcher Rd
Nampa, ID 83687

Call (208) 466-4051

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