[4:08 PM] Jordan Coppedge

Driver Job Application

Read This Before Completing Application.

This Company is an equal opportunity employer. All statements made by applicants for employment on this application form will be carefully checked for accuracy. We offer employment opportunities to all persons without regard to race, color, religion, age, sex, national origin, or handicap/disability. The use of this form does not mean that there are positions open and does not obligate this Company in any way. Answer all questions.

Personal Information

List your addresses of residency for the past 3 years.

Employment Desired

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). Continue to employment questions on next page.

Present (or most recent) Employer

Previous Employer

Previous Employer

Previous Employer

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years.

Current License

Previous License

Driving Experience

Straight Truck

Tractor and Semi Trailer

Tractor Two Trailers

Tractor Three Trailers

Motorcoach-School Bus >8 Persons

Motorcoach-School Bus >15 Persons


Accident Record for the Past 3 Years

Traffic Convictions and Forfeitures for the Past 3 Years (Other than parking violations)


High School/GED



Other Experience or Job-Related Skills


Give the names of people not related to you, whom you have known at least one year.

1st Reference

2nd Reference

3rd Reference

To Be Read and Signed by Applicant

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 as required by 49 CFR 391.23 (d) and (e). I understand that I have a 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 and I cannot agree on the accuracy of the information

I understand that any offer of employment with ER Lewis Construction Co, Inc. is contingent upon the satisfactory results of a Background Check and successful completion of a DOT pre-employment drug screen to be conducted at my expense and at a location to be designated by ER Lewis Construction Co, Inc.

I certify that all the information submitted on this application is true and complete and completed by me. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. In consideration with employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand that, if hired, my employment will be at will and agree that the terms and conditions of employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative other than its president, and then only when in writing and signed by the president, has an authority to enter into any agreement for employment for a specific period of time, or to make any agreement contrary to the foregoing.