Instructions: 
1.) If this application opens in your internet browser window, you may need to copy
and paste the whole document into another application such as notepad, wordpad, or
an email.

You may also save the document to your desktop by choosing FILE--> SAVE AS or
FILE--> SAVE PAGE AS

2.) Wherever you see (________), please replace with the appropriate information.


PERSONAL

Name (Last, First): (________)
Phone: (________)
Address: (________)
City: (________)	State: (________)	Zip: (________)
 
Position Applying: (________)
Type (Full Time, Part Time, Temporary): (________)

Rate of Pay Expected: (________)
Have you ever worked for LVI before? (yes/no): (________)
Date From- (mo/yr): (________)		To- (mo/yr): (________)

EDUCATION

Highest Education Completed (1-12): (________)
Years of College Completed (1-6): (________)
Last School Attended: (________)
Address of School: (________)

GENERAL

Have you ever been convicted of a felony? (yes/no): (________)

If yes, please explain fully in the space below.
Conviction of a crime is not an automatic bar to employment.
(________)




DRIVER EXPERIENCE AND QUALIFICATION

The US Department of Transportation requires driver applicants to state their 
birth date (S391.21(b)(2)

Date of Birth (mo/day/yr): (________)
Social Security Number: (________)
License Number: (________)		State: (________)
Class: (________)			
Endorsements: (________)			
Expiration Date: (________)

A.	Have you ever been denied a license, permit, 
	or privilege to operate a motor vehicle? (yes/no):  (________)

B.	Has any license, permit, or privilege ever been 
	suspended of revoked? (yes/no): (________)

C.	Have you ever been disqualified for violation 
	of the Federal Motor Carrier Safety Regulations? (yes/no): (________)




If you answered yes to A, B, or C, fill in the space below with a full explanation:
(________)







DRIVER EXPERIENCE

Please list the class, type, and dates operated of each vehicle/equipment.
Also, include the dates operated and the approximate miles logged on each 
vehicle/equipment.
(________)









List states operated in during the last 5 years (ex. CO, CA, etc): (________)

Accident Review for the past 3 years.
Please list the nature of the accident, accident date, description of the accident, 
and any injuries or fatalities that occurred.
(________)










Traffic convictions and forfeitures for the past 3 years other than parking violations.
Please list the location, date, charge, and penalty.
(________)











EMPLOYMENT RECORD

Please list all commercial driver employment for the past 10 years.
Start with your current or most recent position and work back.  
Include all military experience.
(________)