Willis Shaw Express

On-line application

PERSONAL INFORMATION:
I am applying: To attend the driving school As a recent driving school graduate As an experienced driver To own and operate my truck leased with WSE
First Name:
Middle Name:
Last Name:
S S #
Address:
City:
State:	Zip:
Phone:	Cell/Pager:
Email:
Date of Birth:
When Is the Best Time to Call You? AM PM
How did you hear about us?

List all previous addresses for the past seven (7) years: Previous address:
Address:
City:
State:	Zip:
How Long?
Previous address:
Address:
City:
State:	Zip:
How Long?
Previous address:
Address:
City:
State:	Zip:
How Long?
Do you possess the legal right to work in the United States? Yes No
Do you read, write and speak the English language? Yes No
Have you ever been employed by this company or any other Comcar Industries, Inc. affiliate? Yes No

EDUCATION / TRAINING:
What is the highest grade completed?
Did you attend a truck driving school? Yes No
If you answered Yes to the previous question: School Name:
Date Graduated: Phone:
City: State:

DRIVER'S LICENSE & ENDORSEMENTS:
List all motor vehicle operating licenses and permits issued to you in the last seven (7) years:
Issuing State: Class: Number: Endorsements: Date Issued: Date Exp:

Issuing State: Class: Number: Endorsements: Date Issued: Date Exp:

Issuing State: Class: Number: Endorsements: Date Issued: Date Exp:

DRIVING EXPERIENCE:
Tractor & Semi-Trailer: Refrigerated: Yes No Van: Yes No Tank: YesNo Flat: Yes No Dump: Yes No Type of Commodities: Years of Experience: Approx Total Miles Driven:
Straight Truck: Refrigerated: Yes No Van: Yes No Tank: YesNo Flat: Yes No Dump: Yes No Type of Commodities: Years of Experience: Approx Total Miles Driven:
Bus: City: Yes No School: Yes No Other: Yes No Years of Experience: Approx Total Miles Driven:

VEHICLE ACCIDENT RECORD:
List all motor vehicle accidents (car, truck, motorcycle, etc.) you have had in the past seven (7) years. Regardless of which driver was “at fault”. YOU MUST PROVIDE THIS INFORMATION.
Name of Employer or Person Who Owned Vehicle:
Address of Employer or Person Who Owned Vehicle:
Date: Location:
Type: Car, Truck, Etc. $ Dollar Amount
Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No

Name of Employer or Person Who Owned Vehicle:
Address of Employer or Person Who Owned Vehicle:
Date: Location:
Type: Car, Truck, Etc. $ Dollar Amount
Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No

Name of Employer or Person Who Owned Vehicle:
Address of Employer or Person Who Owned Vehicle:
Date: Location:
Type: Car, Truck, Etc. $ Dollar Amount
Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No

MOVING VIOLATIONS:
Have you ever had a driver’s license denied, suspended or revoked? Yes No
If yes, when?
Have you ever been convicted of reckless or negligent driving? Yes No
If yes, when?
Have you ever been convicted of a DUI or a DWI? Yes No
If yes, when?
If “yes” to any of the questions listed above, please explain:
List all violations of motor vehicle laws or ordinances (other than parking violations) of which you were convicted or forfeited bond or collateral during the past seven (7) years.
Date:	Violation:
Location:	Penalty:

Date:	Violation:
Location:	Penalty:

Date:	Violation:
Location:	Penalty:

PERSONAL REFERENCES:
Give the names of 3 persons (not relatives) who have know you at least three (3) years:
Name:
Street Address:
City:
State:
Occupation:
Telephone No.

Name:
Street Address:
City:
State:
Occupation:
Telephone No.

Name:
Street Address:
City:
State:
Occupation:
Telephone No.

EMPLOYMENT INFORMATION:
Please answer the following questions about your employment history, going back at least 10 years. Comcar must be able to verify the last 10 years. Please list references to verify periods of self-employment or unemployment.
Current Employer:
Current Employer:
Phone:
Position:
Starting Date:	Pay:
City/State:
Phone:
May We Contact Your Current Employer?
Contact Person:
Why do you want to leave?
..

PAST EMPLOYMENT INFORMATION:
Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:
Contact Person:
Why Did You Leave?
..


Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:
Contact Person:
Why Did You Leave?
..


Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:
Contact Person:
Why Did You Leave?
..

MILITARY SERVICE:
Branch of Service: Date Entered:
Date of Discharge: Rank at Discharge:
Job Duties:
BACKGROUND INFORMATION:
Have you ever been convicted of a misdemeanor? Yes No
Have you ever been convicted of a felony? Yes No
Do you have any criminal charges pending? Yes No
If yes to any of the above, provide the conviction date(s) and detailed explanation(s): (A conviction will not necessarily be a bar to employment. Factors such as age, nature and severity of the offense(s) will be taken into account.)

Have you ever been named as a defendant in a civil case relating to your employment as a commercial motor vehicle driver? Yes No
If yes, provide the litigation date(s) and detailed explanation(s): Being a defendant in a civil or criminal suit will not necessarily be a bar to employment.)


COMMENTS / QUESTIONS:

By clicking the "Submit QuickApp" button below, I certify that I personally completed this application and all information provided is true and correct. I authorize Comcar Industries, Inc. and all of its affiliates ("Comcar") to conduct a background investigation in accordance with state and federal law, and authorize my previous employers to release any information requested by Comcar and hold them harmless from liability for release of said information. Under CFR Part 382.405 and 382.413, I authorize my previous and/or current employers listed above to release results (including any refusal to test) of all drug/alcohol tests, taken by me while in their employ, to Comcar by whatever means is most expedient.
CHECK BEFORE SUBMITTING:
I certify that I have given true, accurate and complete information on this form to the best of my knowledge.

Thank you for completing this information! We will contact you as soon as possible!