DOT Application Form


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DOT Application Form

Please be aware that when you submit this application you are also certifying that the information you are giving is correct and accurate. By submitting your application you are agreeing to the following conditions:

I understand that when I submit this form online I certify that the facts set forth in this Employment Application are true and complete to the best of my knowledge. I understand that falsification, omissions or misstatements may prevent my being hired, or if already hired, may subject me to dismissal. I authorize Park Construction Company to make a thorough investigation of my entire work history, and to verify all data given in my application for employment. I release from liability any person giving or receiving information regarding my personal history, medical information and prior work record. I understand and agree that my employment is for no definite period of time and may be terminated by this company at any time without liability for wages or salary except such as may have been earned at the date of termination. I understand that, if hired, I will abide by all the rules and regulation of Park Construction Company.


DOT Application Form

  • In compliance with Federal and State equal employment opportunities laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
  • All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List the complete mailing address, street number, city, state and zip code.
  • Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
  • (*) IS A REQUIRED FIELD
  • I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: * Review information provided by previous employers; * Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and * Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
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  • Applicant To Complete

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  • List your addresses for the past 3 years

  • Required for Commercial Drivers
  • Dates: FromToRate of PayPosition 
  • Answer only if a job requirement.
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  • Employment History

  • NameAddressCityStateZip 
  • Dates: FromToPosition HeldSalary/Wage 
  • NameAddressCityStateZip 
  • Dates: FromToPosition HeldSalary/Wage 
  • NameAddressCityStateZip 
  • Dates: FromToPosition HeldSalary/Wage 
  • NameAddressCityStateZip 
  • Dates: FromToPosition HeldSalary/Wage 
  • NameAddressCityStateZip 
  • Dates: FromToPosition HeldSalary/Wage 
  • *Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in the quantity requiring placarding.
  • ^The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,0001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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  • ACCIDENT RECORD

  • FOR THE PAST 3 YEARS
  • DateNature of Accident (Head-on, Rear-end, Upset, etc.)FatalitiesInjuriesHazardous Material Spill 
  • DateNature of Accident (Head-on, Rear-end, Upset, etc.)FatalitiesInjuriesHazardous Material Spill 
  • DateNature of Accident (Head-on, Rear-end, Upset, etc.)FatalitiesInjuriesHazardous Material Spill 
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  • EXPERIENCE AND QUALIFICATIONS - DRIVER

  • List all driver licenses or permits held in the past 3 years.
  • StateLicense NumberTypeExpiration Date 
  • StateLicense NumberTypeExpiration Date 
  • StateLicense NumberTypeExpiration Date 
  • DRIVING EXPERIENCE
    Check Yes or No
  • Dates: From (Mo/Yr)To (Mo/Yr)Approx. No. of Miles (Total) 
  • Check Yes or No
  • Dates: From (Mo/Yr)To (Mo/Yr)Approx. No. of Miles (Total) 
  • Check Yes or No
  • Dates: From (Mo/Yr)To (Mo/Yr)Approx. No. of Miles (Total) 
  • Check Yes or No
  • Dates: From (Mo/Yr)To (Mo/Yr)Approx. No. of Miles (Total) 
  • More than 8 passengers
  • More than 15 passengers
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  • Experience and Qualifications - Other

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  • Education

  • Highest Grade Completed (High School, College)Last School Attended & Location (City & State) 
  • This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
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  • MVR RELEASE CONSENT FORM

  • authorize Park Construction or its designated representative(s) to obtain information regarding my driving record in any state at any time while I am employed by (or seeking employment with) the company. I understand that any misstatement of the facts on this form may be grounds for termination of employment. In the event that my MVR indicates that I am a "High Risk Driver" as defined in the glossary of the Fleet Safety Program, I understand that I may be subject to dismissal or company driving privilege suspended or revoked.
  • Driver's License Number:Class:State: 
  • Date of Birth (mm/dd/yyyy)Expiration Date (mm/dd/yyyy) 
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  • AFFIRMATIVE ACTION SURVEY

  • As an employer/government contractor, we must comply with government regulations and affirmative action responsibilities. The information requested below will be used to determine if our recruitment efforts are reaching all segments of the community and will meet our reporting requirements. The information will be used and kept confidential in accordance with the applicable laws and regulations, including those that require the information to be summarized and reported to the Federal Government for Civil Rights enforcement. When reported, the data will not identify any specific individual. This information is voluntary.
  • Military BranchRank 
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  • Form Submit

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