wanship   ENTERPRISES

P O BOX 16090   S.L.C., UT  84116      (455 West  1100 North   North Salt Lake)     801-466-2486  / fax  801-466-2489

DRIVER    APPLICATION    for    EMPLOYMENT

name:

nick nane:

address:

cell phone #

city / state / zip:

home phone #

date of birth:

other phone #

Drivers License #

social security #

License Expires:

Driver License Class:

have HAZMAT endorsement ?

     YES     if NO, will you get?

Medical Card Expires:

person to contact in case of EMERGENCY

Personal References

name:

phone #

address:

family / friend

name:

phone #

address:

family / friend

name:

phone #

address:

family / friend

APPLYING FOR:

FULL TIME     PART TIME     CASUAL/RELIEF

currently employed?

      YES     NO

Date Available:

Rate expected ?

Education:

     9     10     11     12         College   1   2   3

DRIVER LICENSE HELD IN 3 YRS MUST BE SHOWN.

State

License #

Class

Expiration Date

Date:

Location:

Fatalities:

Injuries:

Traffic Violations

Date

Location:

Fatalities:

Injuries:

Accidents

Signature:

Today's Date:

OFFICE      USE      ONLY

           DAC/USIS:                    D/S:                    INS:                   ENT:                    RATE:                    ISD:                    MASTER SHT:

10   years   PAST   EMPLOYMENT   RECORD    391.21 (b)(10)(11)

CURRENT or LAST EMPLOYER

Company Name:

Supervisor:

Address:

Date Started:

Phone #

Date Ended:

Fax #

Salary:

Tractor Driven:

Position Held:

Trailer Pulled:

Reason for Leaving:

States DRIVEN in for this Company:

Accidents ?

2nd last EMPLOYER

Company Name:

Supervisor:

Address:

Date Started:

Phone #

Date Ended:

Fax #

Salary:

Tractor Driven:

Position Held:

Trailer Pulled:

Reason for Leaving:

States DRIVEN in for this Company:

Accidents ?

3rd last EMPLOYER

Company Name:

Supervisor:

Address:

Date Started:

Phone #

Date Ended:

Fax #

Salary:

Tractor Driven:

Position Held:

Trailer Pulled:

Reason for Leaving:

States DRIVEN in for this Company:

Accidents ?

4th last EMPLOYER

Company Name:

Supervisor:

Address:

Date Started:

Phone #

Date Ended:

Fax #

Salary:

Tractor Driven:

Position Held:

Trailer Pulled:

Reason for Leaving:

States DRIVEN in for this Company:

Accidents ?

5th last EMPLOYER

Company Name:

Supervisor:

Address:

Date Started:

Phone #

Date Ended:

Fax #

Salary:

Tractor Driven:

Position Held:

Trailer Pulled:

Reason for Leaving:

States DRIVEN in for this Company:

Accidents ?

1. Have you ever been convicted of a felony ?

YES     NO

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

YES     NO

3. Has your LICENSE, permit or privilege ever been SUSPENDED or REVOKED ?

YES     NO

4. In the past two (2) years, have you ever NOT been EMPLOYED due to incident                        with PRE-EMPLOYMENT DRUG/ALCOHOL testing ?

YES     NO

5. Have you ever tested POSITIVE, REFUSED, or provided a HOT/DILUTE/COLD SAMPLE  in the past two (2) years ?

YES     NO

IF YOU ANSWERED "YES" TO ANY OF THE 5 QUESTIONS… please explain in detail:

wanship   ENTERPRISES

P O BOX 16090   S.L.C., UT  84116      (455 West  1100 North   North Salt Lake)     801-466-2486  / fax  801-466-2489

Cait Smith - Office Manager / Safety

FAX:   801-466-2489

VERIFICATION     OF     PAST     EMPLOYMENT

Applicants Printed Name

Date of Birth:

Signature

Social Security #

Date:

* Dates Employed:                                       To:

Previous Employer / COMPANY NAME

Attn:

* Confirmed Employment DATES *                                                                                                                                                                              

Fax:

The previous employer stated above may release the information below to Wanship Enterprises L.L.C.                                                                                                                          in compliance with D.O.T. Regulation

ABILITY TO WORK WITH OTHERS:     excellent     good     poor

ABUSIVE TO EQUIPMENT ?     YES     NO

SAFETY HABITS:     excellent     good     poor

ANY CARGO CLAIMS ?        YES       NO

ATTITUDE:     excellent     good     poor

ON TIME PICK UP'S/DELIVERIES ?        YES       NO

LOYALTY:     excellent     good     poor

STATES TRAVELED ?

HANDLE MONEY / C.O.D.  ?     YES     NO

EQUIPMENT DRIVEN:

DRIVING SKILLS:     excellent     good     poor

EQUIPMENT PULLED:

DEPENDABLE ?         YES       NO

Reason for Leaving:

PREVENTABLE  ACCIDENTS ?         YES       NO

would you RE-HIRE ?     YES     NO     Upon Review

Drug & Alcohol Testing Results for 3 Previous Yrs

Has this person ever tested POSITIVE for a controlled substance ?        YES     NO

Has this person ever had an ALCOHOL test with a Breath Alcohol Concentration 0.04 or greater in the last three (3) years ?        YES     NO

Has this person ever REFUSED to be tested (including verified adulterated or substituted drug test results) ?         YES     NO

Has this person ever FAILED (delayed, refused, denied, shy, or no showed) while EMPLOYED or doing a PRE-EMPLOYMENT ?        YES     NO

Has this person committed violations of DOT agency & Alcohol Testing Regulations ?        YES     NO

If this person has violated a DOT Drug/Alcohol regulation, do you have documentation of the employee's successful completion of DOT return-to-duty requirements, including follow up tests?        YES     NO

Comments:

8 &C

wanship   ENTERPRISES

P O BOX 16090   S.L.C., UT  84116      (455 West  1100 North   North Salt Lake)     801-466-2486  / fax  801-466-2489

Authorization to obtain INFORMATION  391.21 b,10,11 / 390.15 / 391.23

I, _______________________________________, authorize Wanship Enterprises L.L.C. to obtain information from various consumer reporting agencies regarding my driving record & employment history.

I understand that such information may be required now & from time to time in the future to comply with the safety program of this company and/or requirements of companies providing insurance to this company.

State

License #

Date of Birth

Social Security #

Years of CDL Experience

Date

Location:

Fatalities:

Injuries:

Printed Name:

Date:

Signature:

Full Time      Part Time