Guillory Petroleum Transport

Driver's Application for Employment

Current Address

Addresses - Past Three Years

Add

Do you have the legal right to work in the United States?

Are you presently employed ?

If not, how long since leaving last employment?

Who referred you?

Rate of pay expected?

EXPERIENCE AND QUALIFICATIONS ~ DRIVER

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

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

If the answer is yes to either previous questions, please explain in brief words.

Driving Experience - If none, leave blank

Straight Truck

Tractor and Seml-trailer

Tractor — Two Trailers

Motorcoach — School Bus

Other

ACCIDENT RECORDS FOR PAST 3 YEARS OR MORE. (If no accident - leave blank)

Add

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS). If none leave blank

Add

Education

High School Name

High School City/State

Graduate

Highest Grade Completetd?

College Name

College City/State

Graduate

Hours Completed

Employment Record

NOTE : DOT Requires That Employment for at Least 3 Years and/or Commercial Driving Experience for the Past 10 Years Be Shown.

* * * Please List Employment Beginning with Most Recent Employment * * *

Employer

Add

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it and information in if are true and complete to the best of my knowledge.

Submit