86 Walnut Street, Cullman, Alabama 35055
Phone: 1-800-950-0780 or (256) 739-0710, Fax (256) 737-1813

Driver Application
Equal Opportunity Employer

Company Driver: ____ Lease Operator: ____

Name, Last: _______________ First: ____________________ Middle: _____________

Day Phone:_______________ Evening Phone:_______________ SSN:_______________

Email: __________________________________ Mobile Phone: ________________

ADDRESS:

Street:__________________________________________________ Apt. #:______________

City:_______________________ State/Providence:__________ Zip Code:____________

DRIVERS LICENSE INFORMATION

DL Number: _______________ State of Issue: __________ Date of Exp.: _______________

DRIVER RECORD INFORMATION

Do you have a CDL? ___ Yes ___ No CDL Class: ____________________________

Do you have HAZ-MAT Endorsement? ___ Yes ___ No

Number of citations in last (3) years: _______ Number of accidents in last (3) years: _______

Estimated cost of damages? $ ______________ How many were you at fault? __________

Detail of Citations: (Please include date of offense): ____________________________________

______________________________________________________________________________

Have you ever been arrested for DUI? ___ Yes ___ No

If yes, when were you arrested? ________________ How many offenses? _______________

Have your license ever been revoked? ___ Yes ___ No

If yes, when were they revoked? ________________

Have you ever been convicted of a crime? ___ Yes ___ No

If yes, when were you convicted? _______________

Provide detail of charges: _________________________________________________________

______________________________________________________________________________

CURRENT / PREVIOUS EMPLOYER

Job Title: ______________________ Company Name: ______________________________

Address: ______________________________________ City: __________________________

State / Providence: ______________ Zip: _______ Phone: _______________

Date of Employment: _______ to _______ Starting Pay: $__________ Ending: $__________

Supervisor: ________________________ Reason for Leaving__________________________

Job Description: ________________________________________________________________

_____________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: ______________________ Company Name: ______________________________

Address: ______________________________________ City: __________________________

State / Providence: ______________ Zip: _______ Phone: _______________

Date of Employment: _______ to _______ Starting Pay: $__________ Ending: $__________

Supervisor: ________________________ Reason for Leaving__________________________

Job Description: ________________________________________________________________

_____________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: ______________________ Company Name: ______________________________

Address: ______________________________________ City: __________________________

State / Providence: ______________ Zip: _______ Phone: _______________

Date of Employment: _______ to _______ Starting Pay: $__________ Ending: $__________

Supervisor: ________________________ Reason for Leaving__________________________

Job Description: ________________________________________________________________

_____________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: ______________________ Company Name: ______________________________

Address: ______________________________________ City: __________________________

State / Providence: ______________ Zip: _______ Phone: _______________

Date of Employment: _______ to _______ Starting Pay: $__________ Ending: $__________

Supervisor: ________________________ Reason for Leaving__________________________

Job Description: ________________________________________________________________

_____________________________________________________________________________

PERSONAL REFERENCES

Name:________________________ Relationship:_____________ Contact #:_____________

Date of Availability: ____________________ Shift Preference: ___________________________

By submitting this application; I hereby certify that all information on this form is correct and complete to the best of my knowledge. I hereby authorize McGriff Industries to obtain information concerning my past or current work history, and to do a complete background investigation in accordance with state and federal laws. I hereby release all such persons from any liability or damages.

Applicant Signature: _____________________________________ Date: _______________________