Trans Bridge LinesTrans Bridge Lines
2012 Industrial Drive, Bethlehem, PA 18017
610-868-6001
webmaster@transbridgelines.com
Trans Bridge Lines
Job Application

Your Name (first, middle, maiden, last):


Date of Birth:


Can you show proof of age?
Yes     No

Do you have the legal right to work in the United States?
Yes     No

Telephone no.
  

Cell no.


What position are you interested in?


Are you interested in the McCann Training Program?
Yes     No

Email Address:


List your address(es) of residency for the past 3 years:

Current:
  
City:
  
State:
  
Zip:
  
How long?:
  

Previous:
  
City:
  
State:
  
Zip:
  
How long?:
  

Previous:
  
City:
  
State:
  
Zip:
  
How long?:
  

Have you worked for this company before?
  

Where?
  

Dates:
From:
  To:   

Position:
  

Reason for leaving:
  

Are you now employed?
  

If not, how long since leaving last employment?
  

Did someone refer you?
  

Is there a reason you may not be able to perform the functions of the job for which you have applied as described in the job description?
Yes     No   

Are you looking for full time or part time employment?
  

PROFESSIONAL REFERENCES

Name:
  
Address:

City, State, Zip Code:

Phone:


Name:
  
Address:

City, State, Zip Code:

Phone:


EMPLOYMENT HISTORY

Note: DOT requires that employment of at least 3 years and commerical drivers for 10 years be listed below.

Last employer:
  
Address:

City, State, Zip Code:

Supervisor:

Phone:

Position Held:
   From:   To:
Salary:

Reason for leaving:


Were you subject to the Federal Motor Carrier Safety Regulations while employed?
Yes     No   

Were you subject to the Drug and Alcohol testing requirements of 49CFR Part 40?
Yes     No

Second Last employer:
  
Address

City, State, Zip Code

Supervisor

Phone

Position Held
   From:   To:
Salary

Reason for leaving


Were you subject to the Federal Motor Carrier Safety Regulations while employed?
Yes     No   

Were you subject to the Drug and Alcohol testing requirements of 49CFR Part 40?
Yes     No

Third Last employer:
  
Address

City, State, Zip Code

Supervisor

Phone

Position Held
   From:   To:
Salary

Reason for leaving


Were you subject to the Federal Motor Carrier Safety Regulations while employed?
Yes     No   

Were you subject to the Drug and Alcohol testing requirements of 49CFR Part 40?
Yes     No

Fourth Last employer:
  
Address

City, State, Zip Code

Supervisor

Phone

Position Held
   From:   To:
Salary

Reason for leaving


Were you subject to the Federal Motor Carrier Safety Regulations while employed?
Yes     No   

Were you subject to the Drug and Alcohol testing requirements of 49CFR Part 40?
Yes     No

Fifth Last employer:
  
Address

City, State, Zip Code

Supervisor

Phone

Position Held
   From:   To:
Salary

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations while employed?
Yes     No   

Were you subject to the Drug and Alcohol testing requirements of 49CFR Part 40?
Yes     No

EDUCATION

What is the highest grade completed?
  
High School

College

Last school attended
  

From:
  To:



EXPERIENCE AND QUALIFICATIONS - DRIVER

State
  
License No.

Type

Expiration Date

Note: FMCSR regulations state that a commerical driver may possess only one driver's license.

Do you have a passenger endorsement?

Do you have an airbrake endorsement?


DRIVING EXPERIENCE

Class of equipment
  
Type of equipment (van, tank, flat, etc.)

Dates
  From:   To:   
Approximate no. of miles (total)


Class of equipment
  
Type of equipment (van, tank, flat, etc.)

Dates
  From:   To:   
Approximate no. of miles (total)


Class of equipment
  
Type of equipment (van, tank, flat, etc.)

Dates
  From:   To:   
Approximate no. of miles (total)


Class of equipment
  
Type of equipment (van, tank, flat, etc.)

Dates
  From:   To:   
Approximate no. of miles (total)


ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE

Last accident
  
Nature of accident (head-on, rear-end, upset, etc.)
  
Fatalities
  
Injuries
  

Previous accident
  
Nature of accident (head-on, rear-end, upset, etc.)
  
Fatalities
  
Injuries
  

Previous accident
  
Nature of accident (head-on, rear-end, upset, etc.)
  
Fatalities
  
Injuries
  

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (other than parking violations)

Location
  
Date
  
Charge
  
Penalty
  

Location
  
Date
  
Charge
  
Penalty
  

Location
  
Date
  
Charge
  
Penalty
  

Have you ever been denied a license, permit of priviledge to operate a motor vehicle?
Yes     No  
Has any license, permit or priviledge ever been suspended or revoked?
Yes     No  

If the answer to either of the above questions is yes, please give details:


Show special courses or training that will help you as a driver:


Which safe driving awards do you hold and from whom?



TO BE READ AND ELECTRONICALLY SIGNED BY APPLICANT

This cerities that this application as completed by me, and that all entries on it and information in it are rue and complete the best of my knowledge.
Date:


Applicant signature:



I authorize Trans-Bridge Lines, Inc. to make such investigations and inquiries into my personal, employment, financial or medical history and other related matters as may be necsssary in arriving at an employment decision. 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. I understand that information I provide regarding current/or previous employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have a right to:

 • Review information provided by previous employers;
 • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
 • Have a rebuttal statement attached to the alleged erroneous information, if the employer(s) and I cannot agree on the accurary of the information.

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 Trans-Bridge Lines, Inc.


Applicant signature:


Date:



Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.



1. Have you ever been convicted of a crime(s)?
Yes     No  
If yes, please explain the nature of the offense(s), date(s) of crime(s) and the penalty(ies) imposed:


2. Has your CDL ever been suspended or revoked for any reason(s) including medical, drug, or alcohol?
Yes     No
If yes, please provide details, dates, length of suspension, etc.

3. Have you ever tested positive for drugs or alcohol in a safety sensitive position as defined by the Department of Transporation regulations?
Yes     No
If yes, please provide details as to dates and disposition, etc.

Date:


Applicant signature: