New LIVE: TTI Trucking Application

Online Application
• Please send in a copy of your CDL license after submitting this application.

Dear Applicant: Per FMCSR 391.21 (d) Before an application is submitted, the motor carrier shall inform the applicant that the information he/she provides for the employment history may be used, and the applicant's prior employers may be contacted, for the purpose of investigating the applicant's safety performance history information. The prospective employer must also notify the driver in writing of his/her due process rights as specified in Â§ 391.2(i) regarding information received as a result of these investigations. You the applicant have the following rights: (i) The right to review information provided by previous employers; (ii) 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; (iii) 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.
PERSONAL INFORMATION
Driver Applicant Name

First NameMiddle Name/InitialLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position(s) Applied For:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Social Security Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived here?
Address for Past Three Years:

(Fill out only if different from above.)
Address 2:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live here?
Address 3:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live here?
Did you have the legal right to work in the United States?
Date of Birth: (Required for truck drivers.)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Can you provide proof of age?
In Case of Emergency, Notify:
Emergency Contact Name:

First NameLast Name
Emergency Contact Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Have you worked for this company before?
If Yes...
Where (location):
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Rate of Pay:
Position:
Reason for Leaving:
Are you now employed?
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected:
TRUCK DRIVER JOB DESCRIPTION

Driver is required to be knowledgeable and skilled in loading trailer, securing the load, and driving a semi-truck with trailer. Driver is responsible for performing pre-trip and post-trip vehicle inspections, keeping log on miles, filling out trip reports, etc. Filling fuel tanks, hook and unhook trailers, and performing preventative maintenance inspections.
Are you capable of the above job description?
Are you physically capable of lifting 50 pounds over your head?
Are you physically capable of listing 50 pounds repetitively?
Are you physically capable of sitting and driving for long periods of time?
If applying for flatbed driver position, are you physically capable of pulling chain binder?
If applying for van driver position, are you physically capable of shutting van trailer doors?
Would you be willing to take a pre-placement physical examination?
Would you be willing to take a pre-placement drug test?
Do you have any pending convictions or charged against you?
DRIVERS APPLICATION FOR EMPLOYMENT
EMPLOYMENT RECORD Complete all data for EACH last employer COMPLETELY. The U.S. Department of Transportation requires that the driver applicants show all employment for the past three years. Effective July 1, 1987, they must also show commercial driver employment for the seven years preceding this three year period. Sec. 291.21 (b) (10) 911). Account for any gaps in employment between employers.
Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
2nd Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
3rd Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
4th Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
5th Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
6th Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
7th Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
8th Last Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
Type of Equipment Driven
Areas Driven in
Reason For Leaving
Were you regulated by FMCSA during this Job
Was this job a FMCSA safety sensitive function position subject to DOT regulated controlled substance & alcohol testing?
ACCIDENT RECORD OF PAST 10 YEARS OR MORE
Last Accident
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Kind of Accident
Fatalities
Injuries
Next Previous
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Kind of Accident
Fatalities
Injuries
Next Previous
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Kind of Accident
Fatalities
Injuries
Next Previous
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Kind of Accident
Fatalities
Injuries
Next Previous
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Kind of Accident
Fatalities
Injuries
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 10 YEARS

(Other than parking violations.)
Last Conviction
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Accident
(Head-on, rear-end, upset, etc.)
Fatalities
Injuries
Previous Conviction
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Accident
(Head-on, rear-end, upset, etc.)
Fatalities
Injuries
Previous Conviction
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Accident
(Head-on, rear-end, upset, etc.)
Fatalities
Injuries
Previous Conviction
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Accident
(Head-on, rear-end, upset, etc.)
Fatalities
Injuries
Previous Conviction
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Accident
(Head-on, rear-end, upset, etc.)
Fatalities
Injuries
EDUCATION

Add highest grade completed.
Elementary School:
High School:
College:
Last School Attended:
City:
Did you graduate from Truck Driving School?
Year Graduated:
Where:
EXPERIENCE AND QUALIFICATIONS – DRIVER

Please list each state which you held an operator's license or permit for the last three years
Driver License
State
License No.
Type
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Other Driver License
State
License No.
Type
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Other Driver License
State
License No.
Type
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Has any license, permit or privilege ever been suspended or revoked?
Have you ever been convicted of a felony?
Have you ever been convicted of a DWI/OWI?
Have you 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?
If the answer is yes, did you go to a substance abuse professional for an evaluation?
IF YES TO ANY ANSWER ATTACH STATEMENT GIVING DETAILS!

Cancelof
DRIVING EXPERIENCE

FOR THE PAST TEN YEARS
Class of Equipment
Straight Truck
Type of Equipment
Approx. No. of Miles
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Tractor & Semi-Trailer
Type of Equipment
Approx. No. of Miles
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Tractor - Two Trailers
Type of Equipment
Approx. No. of Miles
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Other
Type of Equipment
Approx. No. of Miles
From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
List states operated in for last five years.
Show special courses or training that will help you as a driver.
Which safe driving award do you hold and from whom?
List flatbed experience for the past 10 years.
List van experience for the past 10 years.
EXPERIENCE AND QUALIFICATIONS – OTHER
Show any trucking, transportation or other experience that may help in your work for this company.
List courses and training other than shown elsewhere in this application.
List courses and training other than shown elsewhere in this application.
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 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. I hereby release employers, schools or persons from all liability in responding to inquiries 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, as permitted by Law.
Enter Your Full Name for Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
REQUEST FOR CHECK OF DRIVING RECORD
I authorize you checking
Enter Your Full Name for Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER
Information Release Authorization
Former Employer
I, {driverApplicant}, hereby {typeA114} {typeA117} to release employment/driving/accident information to T.T.I. Inc. for purposes of investigation as required by Sections 391.23, 382.405, 40.25 and 382.413 of the FMCSA regulations. You are released from any and all liability which may result from furnishing such information. I also realize I may not be offered a job based on information in this report.
Enter Your Full Name for Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
General Consent for Full Query of the Federal Motor Carrier Safety Administration (FCSA) Drug and Alcohol Clearinghouse
I am signing this consent form in connection with my employment or engagement to operate for, or application to become qualified as a commercial driver by TTI INC. (the "Company"). By signing below, I hereby provide consent to the Company to conduct a full query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (the "Clearinghouse") to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I acknowledge and understand that this consent extends to queries to be conducted as part of the Company's initial review of my qualifications to operate as mandated by the Federal Motor Carrier Safety Regulations.

I understand that if the Full query conducted by the Company indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the Company without first obtaining additional specific consent from me.

Finally, I understand that the Company must prohibit me from performing safetysensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations if I: (a) refuse to provide this consent for the Company to conduct a limited query of the Clearinghouse; or (b) refuse to provide the above-described consent to the FMCSA to disclose to the Company any drug or alcohol violation information responsive to a query.
Enter Your Full Name for Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
In connection with your application for employment with T, T. I., Inc., Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, 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.

When the application for employment is submitted by mail, telephone, computer, or other similar means, 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 must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

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. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize T, T. I., Inc. 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 authorizing 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 https://dataqs.fmcsa.dot.gov. If I challenge 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 understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.
I have read the above
Sign below
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
• Please send in a copy of your CDL license after submitting this application.

Mail to:
TTI Inc.
PO Box 188
Eden, WI 53019
Should be Empty:

Online Application

PERSONAL INFORMATION

Address for Past Three Years:

In Case of Emergency, Notify:

If Yes...

TRUCK DRIVER JOB DESCRIPTION

DRIVERS APPLICATION FOR EMPLOYMENT

Last Employer

2nd Last Employer

3rd Last Employer

4th Last Employer

5th Last Employer

6th Last Employer

7th Last Employer

8th Last Employer

ACCIDENT RECORD OF PAST 10 YEARS OR MORE

Last Accident

Next Previous

Next Previous

Next Previous

Next Previous

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 10 YEARS

Last Conviction

Previous Conviction

Previous Conviction

Previous Conviction

Previous Conviction

EDUCATION

EXPERIENCE AND QUALIFICATIONS – DRIVER

Driver License

Other Driver License

Other Driver License

DRIVING EXPERIENCE

Class of Equipment

Straight Truck

Tractor & Semi-Trailer

Tractor - Two Trailers

Other

EXPERIENCE AND QUALIFICATIONS – OTHER

TO BE READ AND SIGNED BY APPLICANT

REQUEST FOR CHECK OF DRIVING RECORD

REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER

General Consent for Full Query of the Federal Motor Carrier Safety Administration (FCSA) Drug and Alcohol Clearinghouse

IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE