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01.
Employment Application
02.
Confirmation
Employment - Excel Oil Service
How did you hear about us?
*
Personal Information
First Name
*
Middle Initial
*
Last Name
*
Email
*
Telephone
*
Cell Phone
Date of Birth
*
Month
Day
Year
Soc. Sec. #
*
Do you have a TWIC Card?
*
Yes
No
Do you have a Passport?
*
Yes
No
Current Address
Enter your addresses for the last three years.
Current Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
How long?
*
Number of previous addresses in the past three years
*
None
One
Two
Previous Address #1
Enter your previous address within the last three years.
Previous Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
How long?
*
Previous Address #2
Enter your previous address within the last three years.
Previous Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
How long?
*
In case of Emergency, notify
Name
*
First
Last
Relationship
*
Phone
*
Why hire me?
Tell us why you feel you are a good fit for our company:
I'm a good fit because...
CDL
NOTE: The D.O.T. requires that no driver possess more than one license. That license must be issued by the state in which you reside. List all CDL information for licenses issued in the past 3 years.
Current License
License #
*
State
*
Type
*
Endorsements
*
Date Issued
*
Month
Day
Year
Expiration Date
*
Month
Day
Year
Previous License
License #
State
Type
Endorsements
Date Issued
Month
Day
Year
Expiration Date
Month
Day
Year
Have you ever had a driver's license revoked or suspended?
*
Yes
No
When (date)
*
Reason
*
Driving Information
LIST ALL CONVICTIONS, MOVING VIOLATIONS, TRAFFIC CITATIONS, ACCIDENTS, and/or DISQUALIFICATIONS IN THE PAST 5 YEARS
Violation #1
Date
Month
Day
Year
Type
Location
Description
Penalty / Fine
Violation #2
Date
Month
Day
Year
Type
Location
Description
Penalty / Fine
Are you familiar with D.O.T. Safety Regulations as they apply to drivers of commercial vehicles and agree to comply with these regulations upon hire?
Yes
No
Have you ever been disqualified by a carrier for violating the D.O.T. Safety Regulations?
Yes
No
Please explain
Have you ever been convicted of a felony?
Yes
No
Please explain
In the past 3 years have you ever tested positive or refused a test on any drug and/or alcohol test? (including compaies applied to, but not worked for)
Yes
No
Experience
What types of cargo have you hauled?
*
Liquid
General
Refrigerated
Hanging Meat
Steel
Other
Hold Shift/Ctrl for multiple selection.
If "Other", list equipment type(s) here:
*
Have you ever hauled Hazardous Materials?
*
No
Yes
What type(s)?
*
Certification Date
*
Month
Day
Year
What types of equipment have you operated?
*
Tanker
Tractor Trailer
Van
Flat
Straight Truck
Other
Hold Shift/Ctrl for multiple selection.
If "Other", list equipment type(s) here:
*
Special Training
List any special courses and/or training you have completed that will help you as a driver.
List courses and/or training here.
Employment History
!!! ATTENTION ALL DRIVER APPLICANTS: All applicants must provide the following information for all companies in which they have been employed/leased to WITHIN THE PAST 10 YEARS. Failure to provide this information in its entirety may result in either a failure to complete or a delay in completing the qualification process due to our inability to verify previous employment as required by regulation. Please list work history in reverse order, beginning from the most recent. Note: ALL DATES IN THE LAST 10 YEARS MUST BE LISTED. If any time is missing, this application will be considered incomplete. If self-employed, list type of work performed and any and all carriers leased to during that time. If self-employed or unemployed for any period of time, you will be required to furnish documentation. !!!
Select the number of employers you've had WITHIN THE PAST 10 YEARS.
*
0
1
2
3
4
5
6
May we contact your current employer?
Yes
No
Company #1
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Company #2
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Company #3
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Company #4
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Company #5
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Company #6
Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Person
First
Last
Phone
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Position Held
Salary / Wage
Reason for Leaving
List Any Accidents
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?
Yes
No
Were you subject to the FMCSRs while employed?
Yes
No
Used Tractor-Trailer
Yes
No
Tanker
Flatbed
Van
Background Certification
In connection with your application for employment with Excel Oil Service, it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer 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, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Excel Oil Service 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 the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer 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 http://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. I have read the above Notice Regarding Background Reports provided to me by "Prospective Employer" and I understand that if hit "submit" on this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
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 further certify that I am currently qualified (and will maintain qualification) as a commercial vehicle driver, in accordance with all FMCSR regulations. I authorize the prospective carrier to perform any investigation pertinent to the position for which I am applying for (including any information required in Parts 382 and 391 of the FMCSR Title 49 Code of Federal Regulations and any Federal and State criminal records). I hereby release all schools, persons, and companies listed above harmless from any and all liability or damages for providing requested information. I agree that by clicking this "Submit" button is my electronic signature and the previous listed regulations are satisfied.
Your application will not be accepted until you: 1) Fill in the confirmation field below, and 2) Click the submit button below. /// *By keying my name in the box below, I am providing an electronic signature. This electronic signature constitutes my consent to the information provided:
Key your name here
*
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Services
▼
Used Oil Collection
Oil Filter Disposal
Drum Waste – Liquid & Solids
Anti-freeze Recycling
Environmental
Products
▼
Industrial Burner Fuel
Spill Supplies
Compliance
▼
Legal Compliance
Environmental Expertise
Related Links
Careers
Get Quote / Service
