Apply for Experienced Class A Truck Driver

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Experienced Class A Truck Driver
ID:1001
Department:Operations
Salary Range:Competitive with O/T after 8 hr day
Contact Information
* First Name:
Middle Name or Initial:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Home Phone:
* Email:
Application Information
Referred By:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Referral Source
* How did you find out about this position ?
Merchandiser
Shopping News
Lancaster Newspaper
Reading Eagle
Radio Add
Internet Add
Drivers License Center Info Screen
Summers Employee
Other
Minimum Qualifications
* Do you have at least 3 years Class A CDL driving experience within the past 5 years
Yes
No
* How many moving traffic convictions have you had in the past 5 years
None
1
2
3 or more
Driver Application for Employment - Summers Trucking
Lester R. Summers, Inc.
40 Garden Spot Road
Suite 100
Ephrata, PA 17522

PERSONAL INFORMATION
* Position(s) Applied For

List your addresses of residency for the past 3 years

Current Address:
Street City State & Zip Code How Long?

Previous Addresses
Street City State & Zip Code How Long?


Referred By
* Social Security No
* Date of Birth
* Have you applied to Summers Trucking at any time in the past?
Yes   No
If Yes When?

DRIVING EXPERIENCE AND QUALIFICATIONS
( List ALL Licenses Held Within the Past 10 Years )
State License No. Type Expiration Date

DRIVING EXPERIENCE

Class of Equipment   Check Type of Trailer Date From(M/Y) Date To(M/Y) Approx No. of Miles (Total)
* Straight Truck
Yes
No
* Tractor - Semi-Trailer
Yes
No
* Tractor - Two Trailers
Yes
No
Other:  

ACCIDENT RECORD FOR THE PAST FIVE YEARS
NONE - I have not been involved in any accidents in the past 5 years. (Note: All Accidents must be listed regardless of fault or type of vehicle driven)
Date Nature of Accident
(Head-on, Rear-End, Upset, Etc.)		 Fatalities Injuries

TRAFFIC CONVICTIONS AND/OR BOND FORFEITURES (PAID A FINE) FOR THE PAST FIVE YEARS
NONE - I have not had any traffic convictions in the past 5 years

Location Date Charge Penalty
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes   No
B. Has any license, permit or privilege ever been suspended or revoked?
Yes   No
C. Have you ever been convicted of a criminal offense?
Yes   No
IF THE ANSWER TO EITHER A , B or C IS YES, GIVE DETAILS:

EMPLOYMENT RECORD
NOTE: Please list ALL employment for the past 10 years

CURRENT/LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

SECOND LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

THIRD LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

FOURTH LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

FIFTH LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

SIXTH LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No

SEVENTH LAST EMPLOYER

Dates Employed Employer/ Contractor Name Employer Address
City, State, Zip
From:

To:
Position Held Contact Person Phone
Reason for Leaving Salary/Wage
Start:

End:
Was this position subject to the Federal Motor Carrier Safety Regulations?:
Yes   No
Was this position designated as a Safety Sensitive Function subject to DOT drug and alcohol testing requirements per 49 CFR Part 40?:
Yes   No


ACKNOWLEDGEMENT OF SAFETY PERFORMANCE HISTORY REQUIREMENTS AND RIGHTS I have made application to Lester R. Summers, Inc., for the purpose of obtaining employment as a Driver of a commercial motor vehicle subject to the Federal Motor Carrier Safety Regulations(FMCSR) and D.O.T. drug and alcohol testing per 49 CFR part 40.

I understand that the information I have provided on this application may be used and that my previous employers will be contacted, for the purpose of investigating my safety performance history as required by FMCSR 391.23.

In addition I have been informed of my due process rights, listed below, specified in FMCSR 391.23(i) regarding information received as a result of these investigations
  1. The right to review information provided by previous employers;
  2. The right to 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. The right to 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.

* Signature (type name):
* Date:

TO BE READ AND SIGNED BY APPLICANT 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 understand that intentionally providing false information and/or failure to fully disclose information requested will disqualify me from consideration for employment.

* Signature (type name):
* Date:
MVR Request Release
* I authorize Summers Trucking to obtain a Motor Vehicle Record from the state in which I am licensed in order to verify my driving record
Yes
No
* Please type your name as your signature
Background Release
I hereby authorize Lester R. Summers, Inc. to investigate my background, prior work history and alcohol and controlled substance testing history to include inquiries from any reporting organization, previous employer, or parties with whom I have been contracted or leased to that may have information about my employment, driving record, job performance, criminal record and results from DOT required alcohol and drug testing.

I also hereby authorize_____________________________________to release all records of employment, including assessments of my job performance, all records and information regarding my driving record, all criminal records and all records and information regarding my alcohol and controlled substances testing to Lester R. Summers, Inc. (or their authorized agents). I hereby release you from any and all liability of any type as a result of furnishing such information to representatives of Lester R. Summers, Inc.

* Date:
* Applicant's Signature (Type Name):
General Consent for Limited Query FMSCA Drug & Alcohol Clearinghouse
* I hereby provide consent to Lester R. Summers Inc. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.  I authorize my consent for pre-employment purposes, as well as any other limited or full queries, which may be required over the duration of my employment, if hired.
I understand that if the limited query conducted by Lester R. Summers Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Lester R. Summers Inc. without first obtaining specific consent from me.
I further understand that if I refuse to provide consent for Lester R. Summers Inc. to conduct a limited or full query of the Clearinghouse, Lester R. Summers will not be able to consider my employment application.

*Please type your name as your signature
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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