Position(s) applied for: *
Last Name: *
First Name: *
Street Address: *
Zip Code: *
How long have you lived here?: *
How long did you live here?:
Do you have the legal right to work in the United States? * YesNo
Date of Birth (required for Commercial Drivers):
Can you provide proof of age? * YesNo
Have you worked for Renaissance Nutrition before? * YesNo
Rate of pay:
Reason for leaving:
Are you now employed? * YesNo
If not, how long since leaving last employment?
Who referred you?
Expected rate of pay:
Have you ever been bonded? (answer only if a job requirement) * YesNo
Name of bonding company:
Is there any reason you might be unable to perform the functions of the job for which you have applied (as defined in the job description)? YesNo
If yes, explain if you wish:
All driver applicants driving in interstate commerce must provide the following information on all employers during the preceding three years. List complete mailing address, street number, city, state, and zip code.
Applicants to drive a commercial motor vehicle1 in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.
Note: Provide information on your past three employers starting with the most recent.
Were you subject to the FMCSRs2 while employed? YesNo
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? YesNo
Dates you were employed (mm/yy): from: to
1 Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding. back ^
2 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 VGWR 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. back ^
Accident record for the past three years or more. If none, enter NONE.
Nature of accident (head-on, rear-end, upset, etc.):
Hazardous material spill:
Traffic convictions and forfeitures for the past three years (other than parking violations). If none, enter NONE.
Driver licenses or permits held in the past three years.
Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo
Has any license, permit, or privilege ever been suspended or revoked? YesNo
If the answer to either of the previous questions is yes, give details:
Straight Truck YesNo
Type of Equipment VanTankFlatDumpRefer
Dates (mm/yy): from: to
Approximate number of miles:
Approx. number of miles:
List states operated in for last five years:
Show special courses or training that will help you as a driver:
Which safe driving awards do you hold and from whom?:
Show any trucking, transportation, or other experience that may help in your work for this company:
List courses and training:
List special equipment or technical materials you can work with (other than those already shown):
High School Attended:
Highest grade level:
Trade School Attended:
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal (Your initials) *