Southco Online Driver Application

Today's date and time is:
1/23/2019 6:42:24 AM

Your employment Application will be kept on file for 1 year from online submittal Date
Southco Distributing Company Online Driver Application
Last Name		First Name		Middle Initial

Date of Birth:		Can you provide documentation to verify Date of Birth? Yes No
Home Phone #		Friend / Neighbor Phone #

Current Address	City	State	ZipCode	How Long Years/Months

Previous Address	City	State	ZipCode	How Long Years/Months

License Information
Drivers Licenses	State	License Number	Type	Expiration Date



Driving Experience
Class of Equipment	Type of Equipment		Dates		Approximate Number of Miles (Total)
	(Van, Tanker, Flat, Etc.)		From	To
Straight Truck
Tractor / Semi Trailer
Tractor / Two Trailers
Other
Accident Record (Additional Remarks Section at the bottom of this form if you need more space to complete this section)
Type	Date	Accident Detail (Head-on, Rear-end, Upset, etc.)		Fatalities	Injuries
Last Accident				Yes No	Yes No
Next Previous				Yes No	Yes No
Next Previous				Yes No	Yes No
Next Previous				Yes No	Yes No
Traffic Conviction / Forfeitures (Other than parking violations, additional remarks section at the bottom of this for if more space is needed)
Location		Date	Charge	Penalty



Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
Has any license, permit or privilege ever been suspended or revoked? Yes No
If the answer to either of the above questions is Yes, please give details on the remarks section at the bottom of this form.
Drivers for Southco Distributing Company may be required to travel overnight on certain routes. Would this be a problem for you? Yes No

Employment History (List in reverse chronological order with last employer first)
1. Most recent employer	Employment Dates		Job Title	Supervisor(s) Name
(Company Name)	From	To

Company address:
Phone number:
Position(s) held:
Reason for leaving:
Describe Duties:
2. Next recent employer	Employment Dates		Job Title	Supervisor(s) Name
(Company Name)	From	To

Company address:
Phone number:
Position(s) held:
Reason for leaving:
Describe Duties:
3. Next recent employer	Employment Dates		Job Title	Supervisor(s) Name
(Company Name)	From	To

Company address:
Phone number:
Position(s) held:
Reason for leaving:
Describe Duties:

Do you have a WorkKeys Career Readiness Certificate (CRC)? Yes No
www.waynecc.edu/works If yes, what is your Career Readiness Certificate level?
Additional Remarks from sections above
Example Section: Then remarks
Date you could start at Southco:			Expected Salary:		Date:

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