OCT (On Call Trucking) Driver Application
Email address *
OCT- P.O. Box 900, Packwood, IA 52580
Please Read
Digital Signature for Agreement Above (You agree that by typing your full name and date below signifies a digital signature) *
Signature Information
Should you obtain employment with OCT Trucking, you may be asked to physically sign a hard copy of an application or document , Thank You
Position Applying For
Name (Last, First, Middle) *
Social Security Number *
Drivers License Number *
Drivers Licence State *
Current Address (Street, City, State, Zip) *
Date of Birth (Month, Day, Year) *
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How Long Have you Been at Your Current Address?
Previous Address (Street, City, State, Zip) *
How Long Did You Reside at Previous Address?
Do You Have a Legal Right to Work in the US? *
Are You Able to Provide Proof of Age? *
Have You Worked for This Company Before? *
If You Previously Worked for Our Company, Please Answer Where, Time Frame (From-To)
What Was Your Rate of Pay (please answer if you previously worked for OCT Trucking)
Position (please answer if previously worked for OCT Trucking)
Reason for Leaving (please answer if you previously worked for OCT Trucking)
Are You Currently Employed? *
If Not Currently Employed, How Long Has it Been Since Last Position?
If You Were Referred to OCT Trucking, Who Were You Referred By:
Rate of Pay Expected?
Is There Any Reason You Might Be Unable to Perform the Functions of the Job for Which You Have Applied? *
If You Answered Yes Above, Please Explain in Detail The Reason You May Be Unable to Perform Job Functions)
EMPLOYMENT HISTORY
For Each Employer Listed Below, Please Provide: Company Name, Company Phone Number, Complete Address Including City and Zip Code, A Contact Person, Contact Phone Number
Please Read
Employer #1 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number) *
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed *
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? *
Employer #2 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number) *
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed *
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? *
Employer #3 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number)
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed
Clear selection
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?
Clear selection
Employer #4 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number)
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed
Clear selection
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?
Clear selection
Employer #5 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number)
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed
Clear selection
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?
Clear selection
Employer #6 (You Must Provide (In order) Company Name, Full Address, Company Phone Number, Contact Name, Contact's Phone Number)
Dates Worked (From-To for Employer Above)
Position Held
Salary Range
Reason for Leaving
Were You Subject to the FMCSRs+ While Employed
Clear selection
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?
Clear selection
Accident History
Please answer questions below related to accidents for the past 3 years
Have you Been In an Accident in the Last 3 Years? *
Accident #1 Details
Enter Details Below for Accident #1 if within the last 3 years
If You Answered Yes Above, Please Enter Details Below Including the Date the Accident Occurred, Nature of Accident (rear end, head on, upset, etc...) If Fatalities, Please List, If Injuries, Please List, If There Was a Hazardous Material Spill, Please List)
Accident # 2
Enter Details Below for Accident #2 if within the last 3 years
Please Enter Details Below Including the Date Accident Occurred, Nature of Accident (rear end, head on, upset, etc...) If Fatalities, Please List, If Injuries, Please List, If There Was a Hazardous Material Spill, Please List)
Accident 3#
Enter Details Below for Accident #3 if within the last 3 years
Please Enter Details Below Including the Date Accident Occurred, Nature of Accident (rear end, head on, upset, etc...) If Fatalities, Please List, If Injuries, Please List, If There Was a Hazardous Material Spill, Please List)
Traffic Convictions
Please list any forfeitures for the past 3 years (other than parking violations) If none, please type "None" in Traffic Convistions #1 below)
Please Provide Details for Traffic Convictions Inlcuding: Date, Location, Charge and Penalty *
Driver Experience and Qualifications
Do You Have Experience Driving a Tractor and Semi Trailer
Clear selection
Check The Type of Equipment that Applies
If You Have Driven a Tractor and Semi Trailer Please List Dates Below (From-To)
If You Have Driven a Tractor and Semi Trailer, Please list the Approx Number of Miles
Do You Have OTR (Over the Road) Experience?
Clear selection
If You Have Taken Any Special Courses or Training that Will Help You as a Driver, Please List Below
If You Hold Safe Driving Awards, Please List, and from Whom
Please list 3 Professional References (Must include: Full Name of Reference, Relationship, Phone Number, Email Address (if feasible) *
Please List Special Equipment or Technical Materials You Are Able to Work With (other than those already listed)
Education:
Please Check Highest Grade Level Completed *
Required
Clear selection
Digital Signature by Applicant
To Sign Digitally, please enter your full name as shown on your birth certificate along with and date of birth
Signature (Type Full Legal Name) & Date of Birth *
Please Enter Today's Date *
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Thank You!!!
OCT Trucking P.O. Box 900, Packwood, IA 52580
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