Comcar Industries - Online Driver Application

COMCAR ONLINE DRIVER APPLICATION

November 20, 2008

Select any or all companies that you wish to apply for. Information on each company is available here.
Coastal Transport Commercial Carrier Corporation CTL Distribution Midwest Coast Transport MD Transport Willis Shaw Other Comcar Affliate - Name: Location:

-- FIELDS IN RED ARE REQUIRED --
First Name:
Middle Name:
Last Name:
SSN:	Using ###-##-#### format
Address:
PO Box / Apt#:
City:
State:
Zip:
Phone:	Using ###-###-#### format
Add'l Phone:	Using ###-###-#### format
Email:
Date of Birth:	Using mm/dd/yyyy format
Best Time to Call:	AM PM

DRIVER INFORMATION

Driver's License #:
Expiration:
State:
Years of Experience:
Endorsements:	[Hazmat: Yes No]
	[Tank: Yes No]
Ever Been Convicted of a Crime?	Yes No If Yes, Explain:
License Ever Suspended/Revoked?	Yes No If Yes, When? Using mm/dd/yyyy format Why?
Number of Moving Violations in the Last Three (3) Years:	Use '0' for none
Any Accidents in the Last Three (3) Years:	Yes No If Yes, When? Using mm/dd/yyyy format
	At Fault? Yes No
	Damage Amount: $
Type of Equipment Operated/Number of Years Each (Enter 0 if none):
Van Tanker Flatbed Other

CURRENT EMPLOYMENT INFORMATION

Please answer the following questions about your employment history, going back at least 10 years. We must be able to verify the last 3 years. Please list references to verify periods of self-employment or unemployment.

Current Employer:
Reference Name:
Position:
Starting Date:
Pay:
City/State:
Phone:	Using ###-###-#### format
May We Contact Your Employer?	Yes No
Contact Person:
Why do you want to leave?
How did you hear about us?

PAST EMPLOYMENT INFORMATION

Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:	Using ###-###-#### format
Contact Person:
Why Did You Leave?

Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:	Using ###-###-#### format
Contact Person:
Why Did You Leave?

Past Employer:
Position:
Dates of Employment:
Pay:
City/State:
Phone:	Using ###-###-#### format
Contact Person:
Why Did You Leave?

COMMENTS/QUESTIONS

Please enter any comments or questions below:

SUBMIT APPLICATION

By clicking the 'Submit' 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.

Having problems? Please email webmaster@comcar.com

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