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+1 (956) 434-GEVI (4384)
info@gevitrans.com
13485 South Unitec Drive
Monday – Friday 9 AM – 6 PM
Gevitrans LLC.
Strive not to be a success, but rather to be of value.
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Complete Name
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Date of Birth (Month, Day, Year)
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Address (City, State, Country, Zip Code)
Total years at this address
Social Security number
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Home Phone
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Use the following format (000) 000-0000
Mobile Phone
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Address last 3 years (Provide city, and state)
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Driver's License Number
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Driver's License Type
Driver's License State of Issuance
Driver's License Expiration Date (Month, Day, Year)
Accidents (Last 3 Years) Year #1
Add date, type of accident, fatality, injuries
Accidents (last 3 years) Year #2
Add date, type of accident, fatality, injuries
Accidents (last 3 years) Year #3
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Type of E-Log system you know how to use / Haved used
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Referenced by (Name)
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E-Mail (Referencee)
Type of vehicle(s) experience (Provide Start and Finish Dates)
Bobtail, Truck/Tractor/Semi-Trailer, Doubles, Other
Conviction (Last 3 years)
Place | Date | Offense | Cargo
Have you ever been denied a driver's license?
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Has your driver's license ever been suspended or revoked?
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If yes, Please explain why and where.
Previous Employment Last Ten Years | (Year 01) *Most Recent*
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 02)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 03)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 04)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 05)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 06)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 07)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 08)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 09)
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Previous Employment Last Ten Years | (Year 10) *Least Recent*
Company Name | Address | Position | Start & Finish Dates | DOT Regulated | Reason for leaving | Supervisor's Name | Phone Number
Have you refused to undergo or had a positive controlled substance test result, or have you had an alcohol test with a result of 0.04 or more within two years prior to applying with this company?
Yes
No
In accordance with FMCSA Part 40.25(j) you are requested to answer the following questions.
If yes, can you provide proof that you have satisfactorily complied with the return to duty process in accordance with the FMCSR’s?
Yes
No
In accordance with FMCSA Part 40.25(j) you are requested to answer the following questions.
Have you ever been convicted of a felony?
Yes
No
In accordance with FMCSA Part 40.25(j) you are requested to answer the following questions.
If yes, please explain:
License + Medical Card
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This certifies that this application was completed by me, and that all entries in it are true and correct to the best of my knowledge.
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