Driver Application

Thanks for your interest in driving for Lowry's and Godfrey's Feed. Fill this out as completely as you can. It takes about 15 minutes, and having your driver's license and work history handy will help. We'll call you once we've had a look.

Prefer paper? Download the printable application (PDF), fill it out and bring it by the store at 1040 Hanover Drive, Madison.

* Required

Applicant information

Position applying for *

Driver Contractor Contractor's driver

Full name *

Phone *

Emergency contact name

Emergency contact phone *

Date of birth *

DOT physical (medical card) expiration

The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

About your Social Security number: to keep it safe, we don't collect it online. We'll get it from you in person when you sign your application.

Current and previous addresses (last 3 years)

Current address

Street address *

City *

State *

ZIP *

Lived here since

Previous address 1

Full address

From

Previous address 2

Full address

From

Have you worked for us before?

Have you worked for this company before? *

Yes No

If yes, from

Reason for leaving

Education

Highest grade completed

Driving experience

Straight truckFromToApprox. miles

Tractor & semi-trailerFromToApprox. miles

Tractor & two trailersFromToApprox. miles

Tractor & triple trailersFromToApprox. miles

Other equipmentFromToApprox. miles

States operated in for the last five (5) years

Special courses or training completed (PTD/DDC, HAZMAT, etc.)

Safe driving awards you hold, and from whom

Accident record for the past three (3) years No accidents in the past 3 years

DateNature (head-on, rear-end, etc.)Location# Fatalities# Injured

Traffic convictions and forfeitures, past three (3) years

Other than parking violations.

No convictions or forfeitures in the past 3 years

DateLocationChargePenalty

Driver's licenses held in the past three (3) years *

StateLicense #Type / classEndorsementsExpiration

A few more questions

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

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)? *

Yes No

Have you ever been convicted of a felony? *

Yes No

If you answered “yes” to any of these, please give details

References

List three (3) people, other than family members, who know your safety habits.

Reference 1

Name *

Phone *

Address

Reference 2

Name

Phone

Address

Reference 3

Name

Phone

Address

Read and sign *

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to obtain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

It is agreed and understood that this application in no way obligates the motor carrier to employ or hire the applicant.

It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

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 have read and agree to the statements above

Type your full name as your signature *

Date *

If we move forward, we'll ask you to sign a paper copy of this application in person.

Driver Application

Present or last employer

Employer 2

Employer 3

Employer 4

Employer 5

Employer 6

Employer 7

Employer 8