Employment – Drivers Application

Drivers Employment Application

Please provide complete and legible information. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information.

Welch Brothers Inc. is an Equal Opportunity Employer. We provide equal employment opportunities without regard to any status protected by applicable federal, Illinois, or local law.

IMPORTANT: For employment to be considered, the applicant must furnish their current Motor Vehicle Report (MVR) along with this application. To obtain your MVR please consult the ILSOS Driving Record Abstract system. If employment is approved, the processing fees ($21.00) will be reimbursed.

Applicant information submitted to Welch Bros., Inc. will be treated as confidential and used only for legitimate employment-related purposes. Access is limited to authorized personnel within Welch Bros., Inc.

Applicant Information (3-Year Address History Required)

Location Applying For: Date of Birth: List all addresses for past 3 years (if different): Legally authorized to work in the U.S.?*

CDL & Licensing Information

Do you hold a valid Commercial Driver’s License?* Expiration Date CDL Class* Have you ever had your CDL suspended, revoked, or canceled?* Medical Examiner's Certificate Expiration Date (DOT Physical Card):

Commercial Driving Experience (Past 3 Years)

Employer 1

Start Date: End Date:

Employer 2

Start Date: End Date:

Employer 3

Start Date: End Date:

Accident History (Past 3 Years)

List all accidents (attach additional sheet if necessary)

Accident 1

Accident Date:

Accident 2

Accident Date:

Accident 3

Accident Date:

Traffic Convictions & Forfeitures (Past 3 Years – Excluding Parking)

No Violations

Violation 1

Violation Date:

Violation 2

Violation Date:

Violation 3

Violation Date:

DOT-Regulated Employment History (Past 3 Years Required)

Employer 1

Subject to DOT Drug & Alcohol Testing?

Employer 2

Subject to DOT Drug & Alcohol Testing?

Employer 3

Subject to DOT Drug & Alcohol Testing?

WBI DOT & Applicant Certifications

PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING.

I certify that the information provided in this application is true and complete. I understand that false statements or omissions may result in disqualification or termination.