Driver's Application for Employment
Wylie Wilson Trucking, Inc.
 1210 Brick Ave
P.O. Box 71
Red Wing, MN 55066

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, or non-job related disability.

If you have additional information that will not fit in the blanks below, please save your information into a
Word document or a Notepad document and attach it with the "Attach" feature at the bottom of this page. -Thank You!

Position(s) Applied For: 
Personal Information
First Name: 
Middle Initial: 
Last Name: 
Address 1: 
Address 2: 
City, State, Zip: 
How Long?: 

Email Address: 

Phone Number: 

Social Security Number: 

Date of Birth: 

*Required for Commercial Drivers

Can you provide proof of age? 

   

Available Start Date: 

 
Previous Addresses - {List your addresses of residency for the past 3 years.}
Address 1: 
Address 2: 
City, State, Zip: 

How Long?: 
Address 1: 
Address 2: 
City, State, Zip: 

How Long?: 
Address 1: 
Address 2: 
City, State, Zip: 

How Long?: 
Employment Details

Have you ever worked for this company before? 

   

 Where: 

Dates: (From)   (To)

   

 Reason for leaving:

Rate of pay:  Position:

Are you employed now?  

If not, how long since leaving last employment?

Who refered you?

Rate of pay expected:
Is there any reason that you might be unable to perfom the functions of the job for which you have applied?  Yes    No
* If you answered "Yes" to the above question, explain below if you wish to do so.



Employment and Driving History

~ All driver applicants to drive in interstate commerce must provide the following information on all employers
during the preceding 3 years.  List complete mailing address, street number, city, state and zip code.

~ 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 such vehicles.
-Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to
transport hazardous materials in a quantity requiring placarding. )

Employment History  (List employers in reverse order starting with the most recent.)

Employer: 

Address: 

City, State, Zip: 

Phone: 

Job Title: 

Supervisor Name: 

Reason For Leaving: 
 

Start Date: 

End Date: 

Work Performed: 

Salary/Wage: 

May We Check References? 

  

Employer: 

Address: 

City, State, Zip: 

Phone: 

Job Title: 

Supervisor Name: 

Reason For Leaving: 
 

Start Date: 

End Date: 

Work Performed: 

Salary/Wage: 

May We Check References? 

  

Employer: 

Address: 

City, State, Zip: 

Phone: 

Job Title: 

Supervisor Name: 

Reason For Leaving: 
 

Start Date: 

End Date: 

Work Performed: 

Salary/Wage: 

May We Check References? 

  

Employer: 

Address: 

City, State, Zip: 

Phone: 

Job Title: 

Supervisor Name: 

Reason For Leaving: 
 

Start Date: 

End Date: 

Work Performed: 

Salary/Wage: 

May We Check References? 

  

Employer: 

Address: 

City, State, Zip: 

Phone: 

Job Title: 

Supervisor Name: 

Reason For Leaving: 
 

Start Date: 

End Date: 

Work Performed: 

Salary/Wage: 

May We Check References? 

  

Accident Record (List all accidents on your record from the past 3 years - If none, enter 0.)

Please enter the number of accidents you have been in: 
(Last Account) - Date: 
Nature of Accident: 
(head-on, rear-end, upset, etc...)
Number of Fatalities: 

Number of Injuries: 
(Next Previous) - Date: 
Nature of Accident: 
(head-on, rear-end, upset, etc...)
Number of Fatalities: 

Number of Injuries: 
(Next Previous) - Date: 
Nature of Accident: 
(head-on, rear-end, upset, etc...)
Number of Fatalities: 

Number of Injuries: 
Traffic Convictions (All traffic convictions or forfeitures from the past 3 years - If none, enter 0.)

Please enter the number of traffic convictions you've had over the past 3 years: 
Location: 
Date: 
Charge: 

Penalty: 
Location: 
Date: 
Charge: 

Penalty: 
Location: 
Date: 
Charge: 

Penalty: 



Education & Experience

Education Education

High School  

Name: 

Address: 

Graduated?
  Yes
  No
  In Progress

Diploma:     -Or-
Last Grade Completed: 

Business, Trade, 
or Tech School 

Name: 

Address: 

Graduated?
  Yes
  No
  In Progress

Degree: 

College, 
Undergraduate 

Name: 

Address: 

Graduated?
  Yes
  No
  In Progress

Degree: 

College, 
Graduate 

Name: 

Address: 

Graduated?
  Yes
  No
  In Progress

Degree: 

Other Education 

Name: 

Address: 

Graduated?
  Yes
  No
  In Progress

Degree: 
Qualifications

Driver Licenses  

State: 

State:

State:

License No.:

License No.:

License No.:

Type: 

Type:

Type:

Expiration Date: 

Expiration Date:

Expiration Date:

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? 

   

B. Has any license, permit or privilege ever been suspended or revoked? 

   

If the answer to A or B is YES.....Please explain below: 
Driving Experience
Class of Equipment   Type of Equipment
(van,tank,flat,etc.)  		 Dates
From      -      To 		 Approx. Miles  
Straight Truck
Tractor & Semi-Trailer
Tractor - Two Trailers
Motor Coach - School Bus
Other

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?

Experience & Qualifications - Other

Please list 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 Special Equipment or Technical Materials you can work with (other than those already shown).


Attachments  (Attach up to 3 documents if necessary)

1. Attachments should be in Word, PDF, or Plain Text, and not larger than 100K.

2. Make sure that your full name is in the file name (ex. Work History - John Doe.doc).

3. Attach documents with:
    a.) Additional "Previous Employment"
    b.) Additional "Accident Information"
    c.) Additional "Traffic Conviction Info"
    d.) Other (ex. Resume, More Driver Licenses, etc...)



Applicant's Statement
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. (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.
.

Fair Credit Reporting Act Disclosure Statement
In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

.