JVC Enterprises Transportation Services

Address: 1139 73rd St SW, Byron Center, MI 49315

Diver Application Form

  • JVC Driver Application
  • I Authorize you to make such investigations and inquiries of 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.
  • 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 rules and regulations of the company.
  • 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.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Employment History
  • All applicants wishing to drive interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten-year employment record).
  • Current or last employer:
  • Second Last Employer:
  • Third Last Employer:
  • Any gaps in employment and/or unemployment Must be Explained.
  • The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
  • EXPERIENCE AND QUALIFICATION
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • TYPE OF EQUIPMENT Van/Reefer/Flat/TankDATES FROM – TOORAPPROXIMATE NUMBER OF MILES 
  • ACCIDENT HISTORY (3 Years)
  • Date M/YNature of accidentNumber of FatalitiesNumber of InjuriesHazardous Materials Spills 
  • TRAFFIC CONVICTIONS and FORFEITURES (past 3 years)
  • Date Convicted M/YViolationState of ViolationNumber of Points 
  • LICENSE INFORMATION
  • Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.