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Driver Application

Please fill out the multi-part form below to submit an application for a driver position.
We take your personal information seriously, we will not share or sell the information you provide us.

Dump Truck Driver Application

Driver Application – Section 1 – Minimum Requirements – Step 1 of 12

Gene Nicholas, LLC Minimum Dump Truck Driver Requirements

You must meet the minimum requirements to proceed with the application.
Any field in this application marked with a * is a required field.

Do you have a minimum of an Arkansas Class B CDL? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Are you at least 25 years old? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Do you have at least 3 years of CDL driving experience? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Can you drive a manual truck? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Do you have a current Medical Card? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Do you have reliable transportation? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Do you have a cell phone capable of receiving phone calls and text messages? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answer.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Please confirm. Can you meet all of the minimum requirements in the questions above? *

Yes
No

SORRY!

You do not meet the minimum requirements to be a Dump Truck Driver for Gene Nicholas, LLC. If you feel this is an error, please review your answers.

To learn more about the requirements to be a driver for Gene Nicholas, LLC you can click here.

Name, Phone Number, E-Mail and Address

We require at least 3 years of residence history.

Name *

First

Middle

Last

Date of Birth *

MM/DD/YYYY

Phone Number *

Email *

Email

Confirm Email

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Have you lived at your current address for at least 3 years? *

Yes
No

Address

Address Line 1

Address Line 2

City

State

Zip Code

Address

Address Line 1

Address Line 2

City

State

Zip Code

Address

Address Line 1

Address Line 2

City

State

Zip Code

EMERGENCY CONTACT INFORMATION

Please provide the names and phone numbers of persons whom you would like to be contacted in the event of an emergency.
You must have at least one emergency contact!

Primary Emergency Contact

Name *

Primary Emergency Contact Name

Phone *

Primary Emergency Contact Phone Number

Relationship *

Spouse, Mother, Father, Brother, Friend, etc.

DRIVER EXPERIENCE AND QUALIFICATIONS

Answer all questions completely.

Licenses

Drivers licenses held in the past 3 years must be shown.

State *

Enter the State where your license was issued

License Number *

Enter your License Number

Class *

Choose the Class of your CDL

Endorsements *

List any endorsements you have separated by a comma, or enter N/A for none.

Expiration Date *

Enter the date when your license expires.

Have you had this license for at least 3 years? *

Yes
No

State *

Enter the state where your license was issued

License Number *

Enter the license number

Class *

Choose the class of the CDL

Endorsements *

List any endorsements you have separated by a comma, or enter N/A for none.

Expiration Date *

Do the above two licenses combined total at least 3 years? *

Yes
No

State *

Enter the state where your license was issued

License Number *

Enter the license number

Class *

Choose the class of the CDL

Endorsements *

List any endorsements you have separated by a comma, or enter N/A for none.

Expiration Date *

Do the above three licenses combined total at least 3 years? *

Yes
No

State *

Enter the state where your license was issued

License Number *

Enter the license number

Class *

Choose the class of the CDL

Endorsements *

List any endorsements you have separated by a comma, or enter N/A for none.

Expiration Date *

Do the above four licenses combined total at least 3 years? *

Yes
No

Please Explain *

Explain your licensing situation

Licenses and Failed Test Information

Answer all questions completely.

40.25(j) Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug/alcohol testing rules during the past 2 years? *

Yes
No

You answered "Yes" to the 40.25(j) question. Can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements? *

Yes
No

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *

Yes
No

Please Explain *

Has any license, permit or privilege ever been suspended or revoked? *

Yes
No

Please Explain *

Driving Experience

Class of Equipment

Straight Truck

Type of Equipment

Van, Tanker, Flat, Reefer, etc.

Date From

Date To

Approximate Total Miles

Class of Equipment

Tractor/Trailer

Type of Equipment

Van, Tanker, Flat, Reefer, etc.

Date From

Date To

Approximate Total Miles

Class of Equipment

Doubles/Triples

Type of Equipment

Van, Tanker, Flat, Reefer, etc.

Date From

Date To

Approximate Total Miles

Class of Equipment

Bus

Type of Equipment

Van, Tanker, Flat, Reefer, etc.

Date From

Date To

Approximate Total Miles

ACCIDENT REVIEW FOR THE PAST 3 YEARS

Nature of Accident

Head-on, Rear-end, Overturn, backing, etc.

Were there any fatalities?

Yes
No

Were there any injuries?

Yes
No

Date Occurred

Nature of Accident

Head-on, Rear-end, Overturn, backing, etc.

Were there any fatalities?

Yes
No

Were there any injuries?

Yes
No

Date Occurred

Nature of Accident

Head-on, Rear-end, Overturn, backing, etc.

Were there any fatalities?

Yes
No

Were there any injuries?

Yes
No

Date Occurred

Nature of Accident

Head-on, Rear-end, Overturn, backing, etc.

Were there any fatalities?

Yes
No

Were there any injuries?

Yes
No

Date Occurred

TRAFFIC CONVICTIONS AND FORFEITURES

Please list any traffic convictions for the past 3 years other than parking violations.

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

EMPLOYMENT HISTORY INFORMATION

Please provide the last 10 years of your employmeny history

Company *

Company Address *

Position Held *

Date From *

Supervisor's Name *

Company Phone *

Salary *

Date To *

Reason for Leaving *

391.21 Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer? *

Yes
No

Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as required by 49 CFR part 40? *

Yes
No

Do you want to add a second previous employer?

Yes
No

Company

Company Address

Position Held

Date From

Supervisor's Name

Company Phone

Salary

Date To

Reason for Leaving

391.21 Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?

Yes
No

Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as required by 49 CFR part 40?

Yes
No

Do you want to add a third previous employer?

Yes
No

Company

Company Address

Position Held

Date From

Supervisor's Name

Company Phone

Salary

Date To

Reason for Leaving

391.21 Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?

Yes
No

Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as required by 49 CFR part 40?

Yes
No

Do you want to add a fourth previous employer?

Yes
No

Company

Company Address

Position Held

Date From

Supervisor's Name

Company Phone

Salary

Date To

Reason for Leaving

391.21 Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?

Yes
No

Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as required by 49 CFR part 40?

Yes
No

Do you want to add a fifth previous employer?

Yes
No

Company

Company Address

Position Held

Date From

Supervisor's Name

Company Phone

Salary

Date To

Reason for Leaving

391.21 Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?

Yes
No

Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as required by 49 CFR part 40?

Yes
No

UPLOAD YOUR RESUME

Here you have an option of uploading your resume. Only .pdf file types are supported.

Upload your Resume

Click or drag a file to this area to upload.

You can either drag your resume here or click in this box to select your resume and upload it with your application. Only .pdf file types are supported.

CDL License Upload

Please take a picture of your CDL license and upload it here.

Upload a picture of your CDL license in .jpg or .jpeg format here. *

Click or drag a file to this area to upload.

You can either drag your picture here or click in this box to select your picture and upload it with your application. Only .jpg or .jpeg file types are supported.

Updating preview…

This is a preview of your Driver Application submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.

ACKNOWLEDGEMENTS

Please read the following statements. You must check the box for each statement after you have read it.

I have been informed by Gene Nicholas, LLC that the previous employment information I have given for the preceeding 3 years with FMCSA regulated entities will be investigated by contacting my previoius employers for the purpose of obtaining my safety performance history as required by paragraphs (d) and (e) of 391.23. *

Yes, I Acknowledge

Gene Nicholas, LLC has advised me, during the application process, that I have the following due process rights regarding information received from previous employers as a result of these investigations conducted on my safety performance history. In accordance with 391.23(i) I have been advised that I have the right to review information provided by previous employers; I have the right to have errors in the information corrected by the previous employer and for that employer to re-send the corrected information to Gene Nicholas, LLC; I have the right to 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 have been informed that my previous Department of Transportation regulated employment history in the previous (3) years can be reviewed by me submitting a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. Gene Nicholas, LLC has advised me that within (5) business days of receiving the information, they will supply me the information to me. Gene Nicholas, LLC has advised me that if I have not arranged to pick up or receive the requested records within (30) days of making them available, Gene Nicholas, LLC may consider I have waived the request to review the records. All information obtained is to be used in the decision making process for employment with Gene Nicholas, LLC. *

Yes, I Acknowledge

It has been recommended to me to read 49 CFR Part 391.23 to be more aware of the procedures motor carriers are required to use to obtain or review my safety performance history with previous DOT regulated motor carriers. *

Yes, I Acknowledge

This certifies that this application was completed by me, and that all entries on it and the information in it are true and complete to the best of my knowledge. *

Yes, I Acknowledge

DATE AND SIGN

Please select the Date, Enter your name and signature in the appropriate boxes.

Date *

Select today’s date

Name *

First

Last

Signature *

Clear Signature

Please sign with your mouse or finger

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479-750-1294
12640 Ervin McGarrah Rd
Lowell, AR 72745

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