All services operate 7 days/week 365 days/year unless cancelled for weather. Driver’s Application for Employment Driver's Application for Employment Electronic Version of Application for web submission. Driver's Application for Employment* 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 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. Premier Coach 946 Route 7 South Milton, VT 05468 1-800-532-1811 Applicant Signature*By typing my name in the box above I represent it as my signature and I authorize Premier Coach Company and Vermont Translines to fully investigate my background. Date* MM slash DD slash YYYY We are an equal opportunity employer 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 any other protected group status.To attach a resume and cover letter please drag file here or click "Select Files" to browse. To complete our online application, please fill out the information below and skip this upload option. Drop files here or Select files Max. file size: 50 MB, Max. files: 6. Position Applied for*Are you interested in full or part time?Which terminal location is your preference? You may choose more than one. Milton, VT Rutland, VT Warner, NH Potsdam, NY Rate of pay expectedName* First Last Email* Enter Email Confirm Email Phone*Date of birth (Required for Commercial Drivers)Social Security NumberList your addresses for the past 3 years.* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long here?Previous Address Street Address City State / Province / Region ZIP / Postal Code How long did you live here?Do you have the legal right to work in the United States? Yes No If you have worked for this company before, please list when and where.Are you employed now? Yes No If not employed now, how long since leaving your last employment?How did you hear of our company? If referred by someone, please let us know.Have you ever been bonded?Name of bonding companyHave you ever been convicted of a felony?If yes, please explain felony conviction. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered. Use as much space as needed, box will expand to fit your entire submission.Is there any reason you might be unable to perform the functions of the job for which you are applying?Employment HistoryAll driver applicants to drive in interstate commerce must provide the following information on all employers during the preceeding three years. List complete mailing address for each employer. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years of information on those employers for whom the applicant operated a motor vehicle. Note: List employers starting with most recent and working backward. Use the free-form text box at the end of the application for additional employers if needed to cover a total of 10 years of employment history. Most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected to the FMCSRs while employed? Yes No FMCSRs Information: 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 1,001 pounds or more, (2) Is designed or used to transport 9 or more passengers, OR (3) Is of any size and is used to transport hazardous materials in a quantity requiring placarding.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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*Next EmployerSecond most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected 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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*Next EmployerThird most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected 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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*Next EmployerFourth most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected 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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*Next EmployerFifth most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected 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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*Next EmployerSixth most recent employer Employer Name Address City State / Province / Region ZIP / Postal Code PositionRate of payEmployer phoneEmployer Email Name of supervisor First Last Were you subjected 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 Employed From* MM slash DD slash YYYY to* MM slash DD slash YYYY Reason for Leaving*About your driving recordAccident record for past 3 yearsDate of AccidentNature of Accident (head-on, rear-end, upset, etc...Fatalities?Injuries?Hazardous Spill? Traffic Convictons and forfeitures for the past 3 years, other than parking violations. (If none, write NONE.)LocationDateChargePenalty List all driver licenses or permits held in the past 3 yearsStateLicense #TypeExpiration Date Have you ever been denied a license, permit of privilege to operate a motor vehicle? No Yes If yes, provide detailsHas any license, permit or privilege ever been suspended or revoked? No Yes If yes, provide detailsDriver licenses or permits held in the past 3 yearsStraight TruckExperience?Type of EquipmentDates: List From & ToApproximate total number of miles driven NoYesVanTankFlatDumpFefer Tractor and Semi-TrailerExperience?Type of EquipmentDates: List From & ToApproximate total number of miles driven NoYesVanTankFlatDumpFefer Tractor -Two TrailersExperience?Type of EquipmentDates: List From & ToApproximate total number of miles driven NoYesVanTankFlatDumpFefer Tractor -Three TrailersExperience?Type of EquipmentDates: List From & ToApproximate total number of miles driven NoYesVanTankFlatDumpFefer Motor Coach - School bus (More than 8 passengers)Experience?Dates: List From & ToApproximate total number of miles driven NoYes Motor Coach - School bus (More than 16 passengers)Experience?Dates: List From & ToApproximate total number of miles driven NoYes List states operated in for the last 5 yearsList special courses or training that will help you as a driverList safe-driving awards you hold and from whomList any trucking, transportation or other experience that may help in your work for this companyList courses and training other than those shown elsewhere in this applicationList special equipment or technical materials you can work with other than any listed elsewhere in this applicationEducationGrade School - Highest grade completed 1 2 3 4 5 6 7 8 HIgh School - Highest grade completed 9 10 11 12 College - Number years attended, if any 1 2 3 4 College Degree Earned? Yes No If yes, what degree was earned in college?To be read and signed by the applicant.By typing my name in the box above which represents my signature and I certify that this application was completed by me and that all entries are true and complete to the best of my knowledge. Commercial Vehicle Driver Applicant Controlled Substance and Alcohol Questionaire Pursuant to 49 CFR part 40.25(j)Name Prefix First Last Suffix Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Birthdate MM slash DD slash YYYY Social Security NumberHome PhoneCell PhoneEmail Date MM slash DD slash YYYY Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years? Yes No If yes, have you successullly completed the return-to-duty process? Yes No If yes, documentation MUST BE PROVIDED before any safety-sensitive transportation function is performed. To be read and signed by the applicant.By typing my name in the box above which represents my signature and I certify that this Controlled Substance and Alcohol Questionaire was completed by me and that all entries are true and complete to the best of my knowledge. Certification* 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. Date* MM slash DD slash YYYY Applicant's Electronic Signature*CommentsThis field is for validation purposes and should be left unchanged. Δ
