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Equipment Experience

Type of Equipment	Date From	Date To	Total Miles
Straight Truck	This is required	This is required	This is required
Tractor/Trailer	This is required	This is required	This is required
Tractor/2 Trailers	This is required	This is required	This is required
Tandem Dump	This is required	This is required	This is required
Tri-axle Dump	This is required	This is required	This is required
Pup Trailer	This is required	This is required	This is required

Robin Lynne Inc

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Enter your phone number Enter a valid number like +1555-123-4567

Enter an email Use an address with (@) and (.)

Personal Information

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Current Address

This is required

Previous Address(es): past 3 years

Previous Address#1

This is required

This is required Enter a phone number

This is required

Previous Address#2

This is required

This is required Enter a phone number

This is required

Previous Address#3

This is required

This is required Enter a phone number

This is required

For checking prior records, provide other names under which you have worked:

This is required

Have you been convicted of a felony within the last five years?

Yes

This is required

Position Applying For

This is required

This is required Enter a phone number

Can you, after employment, submit evidence of your lawful right to work in the US?(Proof of citizenship or immigration status may be required upon employment.)

Yes

This is required

Have you filed an application here before?

Yes

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If yes, give date

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Have you ever been employed here before?

Yes

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If yes, give date

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Experience and Qualifications - Driver

Driver Licenses

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Driver Licenses#2

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Equipment Experience

Type of Equipment - Straight Truck

This is required

Type of Equipment - Tractor/Trailer

This is required

Type of Equipment - Tractor/2 Trailers

This is required

Type of Equipment - Tandem Dump

This is required

Type of Equipment - Tr-axle Dump

This is required

Type of Equipment - Pup Trailer

This is required

Other Experience

Task:

Spreading Rock

Yes

This is required

Hauling Asphalt

Yes

This is required

Truck Washing

Yes

This is required

Changing Oil

Yes

This is required

Vehicle Inspections

Yes

This is required

Adjust Air Brakes

Yes

This is required

Truck Lubrication

Yes

This is required

Changing Tires

Yes

This is required

Transmission Types Driven

8 Speed

9 Speed

10 Speed

13 Speed

Other

This is required

Accident Records For Past Three Years

Occurrence - Last Accident

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Fatalities

Yes

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Injuries

Yes

This is required

Occurrence - Next Accident

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This is required

Fatalities

Yes

This is required

Injuries

Yes

This is required

Occurrence - Next Accident

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This is required

Fatalities

Yes

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Injuries

Yes

This is required

PREVIOUS EMPLOYER

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Enter your phone number Enter a valid number like +1555-123-4567

This is required

EMPLOYED (Month & Year)

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RATE OF PAY:

This is required

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason

This is required

PREVIOUS EMPLOYER #2

This is required

Enter your phone number Enter a valid number like +1555-123-4567

This is required

EMPLOYED (Month & Year)

This is required

RATE OF PAY:

This is required

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason

This is required

PREVIOUS EMPLOYER #3

This is required

Enter your phone number Enter a valid number like +1555-123-4567

This is required

EMPLOYED (Month & Year)

This is required

RATE OF PAY:

This is required

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason

This is required

Are you employed now?

Yes

This is required

If yes; may we contact your current employer?

Yes

This is required

Are you available to work:

Full-time

Part-time

Days

Nights

Weekends

This is required

Education

High School

This is required

College or University

This is required

Business or Technical

This is required

Other

This is required

List any, other experience or training that will help us determine your qualifications for the position applied for:

This is required

Experience Record - Maintenance and Shop Mechanic Only

Number of year's experience:

This is required

Familiar with what types of equipment (i.e. Peterbilt, Freightliner, International, etc.)?

This is required

Specialized in any phase (i.e. Carburettors, Pumps, Front End, etc.)?

This is required

Additional Experience

This is required

Axles & Frames

This is required

Body & Fender

This is required

Brakes

This is required

Electrical

This is required

Lubrication

This is required

Painting

This is required

Preventative Maint (truck & trailer)

This is required

Tire Change and Repair

This is required

Trailer Repair (Type)

This is required

Transmission/Differential

This is required

Welding (Arc/Gas)

Certification of Violations

This is required

I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months

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If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.

This is required

Review and Evaluation of Driver's Record:

In accordance with Section 391.25, Motor Carrier Safety Regulations, all information pertinent to the above driver's safety of operations, including the list of violations furnished by him in accordance with Section 391.27, has been reviewed for the past 12 months.

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Authorization & Request for Drug and Alcohol History

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Driver was subject to Department of Transportation testing requirements....

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Has this person had an alcohol test with the result of 0.04 or higher alcohol concentration?

Yes

This is required

Has this person tested positive or adulterated or substituted a test specimen for controlled substances?

Yes

This is required

Has this person refused to submit to a post-accident, random, reasonable suspicion or follow-up alcohol or controlled substance test?

Yes

This is required

Has this person committed other violations of Subpart B of Part 382 or Part 40?

Yes

This is required

If this person has violated a DOT drug and alcohol regulation, did this person complete a SAP-prescribed rehabilitation program in your employ, including return-to-duty and follow-up tests? If yes, please send documentation back with this form.

Yes

This is required

For a driver who successfully completed a SAP's rehabilitation referral and remained in your employ, did this driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested?

Yes

This is required

In answering these questions, include any required DOT drug or alcohol testing information obtained from

previous employers in the previous 3 years prior to the date on this form.

This is required

This is required Enter a phone number

This is required

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TO BE READ AND SIGNED BY THE APPLICANT

Consumer Reports May Be Obtained as Part of My Evaluation for Employment. The Reports May Be Procured by Anderson Insurance Agency, Inc. and May Include My Driving Record, an Assessment of My Insurability Under the Company’s Insurance Coverages, or Other Consumer Reports. By Signing This Disclosure, I Hereby Authorize the Company to Procure Such Reports, and Additional Reports About Me From Time to Time, as It Deems Appropriate, to Evaluate My Insurability or for Other Permissible Purposes.

This is required

I Authorize You to Make Such Investigations and Inquiries to 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.

This is required

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 the Rules and Regulations of the Company.

This is required

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 current/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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This Certifies That I Have Completed This Application, And That All Entries On It And The Information In It Are True And Complete To The Best Of My Knowledge.

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Acknowledgement & Authorization Form

I acknowledge receipt of Robin Lynne, Inc. Department of Transportation Drug & Alcohol Policy and Procedures.

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All employees will be provided with education and information concerning the effects of alcohol and controlled substance use on an individual’s health, work, and personal life. Additionally, information will be provided identifying the signs and symptoms of an alcohol or controlled substance problem (whether the driver’s or a co-worker’s), as well as the available methods of intervening when such a problem is suspected.

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I acknowledge receipt of Alcohol and Drug Awareness materials.

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I authorize Robin Lynne Inc. to release any and all results of my controlled substances and/or alcohol tests to National Review Offices, Los Angeles, CA.

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Please download and complete our official Driver Application Form for Robin’s Truckers.

Please print it, fill it out manually, and bring it with you to the interview.

Download Application Form

Hiring

We got it.

Equipment Experience

Robin Lynne Inc

Personal Information

Current Address

Previous Address(es): past 3 years

Previous Address#1

Previous Address#2

Previous Address#3

For checking prior records, provide other names under which you have worked:

Position Applying For

If yes, give date

If yes, give date

Experience and Qualifications - Driver

Equipment Experience

Other Experience

Accident Records For Past Three Years

PREVIOUS EMPLOYER

EMPLOYED (Month & Year)

RATE OF PAY:

PREVIOUS EMPLOYER #2

EMPLOYED (Month & Year)

RATE OF PAY:

PREVIOUS EMPLOYER #3

EMPLOYED (Month & Year)

RATE OF PAY:

Education

Experience Record - Maintenance and Shop Mechanic Only

Additional Experience

Axles & Frames

Body & Fender

Brakes

Electrical

Lubrication

Painting

Preventative Maint (truck & trailer)

Tire Change and Repair

Trailer Repair (Type)

Transmission/Differential

Welding (Arc/Gas)

Certification of Violations

Review and Evaluation of Driver's Record:

Authorization & Request for Drug and Alcohol History

TO BE READ AND SIGNED BY THE APPLICANT

Acknowledgement & Authorization Form

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