Pre-Application For Employment

Mike Lowrie Trucking, Inc., Mike Lowrie Transport, Inc., MC Transport Services, Inc.

P.O. Box 207
Dixon, Ca 95620
(707) 678-3018

(ANSWER ALL QUESTIONS COMPLETELY)

In compliance with Federal and State equal employment laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, martial status, veteran status, or non-job related disability or any other projected group status. The Company does not condone and will not tolerate conduct by its employees or management that violates any anti-discrimination laws, and all appropriate action will be taken to enforce this policy.

Items in red are required.

Date of Application: 11/24/2024

Position(s) Applied for:

Name

Social Security #:

Address:

City/State/Zip:

Contact Information:

Date of Birth:

Do you have a legal right to working in the United States?

Yes

Are you now employed?

Yes

If not, when were you last employed?

Have you ever work for this company before?

Yes

Reason for leaving?

Referred By?

Expected Pay?

Have you ever had a DUI, and has your driver’s license ever been suspended, revoked, or denied and if so, explain below.

Is there any reason you might be unable to perform the functions of the job for which you have applied?

Yes

If yes, explain here (Optional):

Accident Record for the past 5 years

Date

(Head-on, Read-end, Etc.)

Fatalities

Injuries

Traffic Convictions and Forfeitures for the past 3 years

Date

Location

Violation

Penalty

Equipment Experience

Approximate Dates

Approximate miles

Tractor - Doubles

Tractor – Flatbed

Tractor – Lowboy

Tractor – Dry – Van

Tractor – Reefer – Van

Tractor – Tanker/Pneumatic

Tractor – End – Dump 30-40’

Tractor – Transfer

Tractor – Log Truck

Tractor – Auto – Transport

Straight Truck

How many years have you driven a commercial motor vehicle:

List States operated in for the past 5 years:

Show special courses or describe training that will help you as a driver:

To be read and signed by applicant

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires 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 inquires 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.

Please type your full legal name:

Today's Date

Mike Lowrie Trucking, Inc., Mike Lowrie Transport, Inc., MC Transport Services, Inc.

Employment History

All applicants must complete the following employment history for the past ten years. List employers starting with the most recent.

Company:

Phone:

Address

City

State

Supervisor

Date From

Date To

Reason for leaving:

Wage/Salary

Position Held:

State(s) Drove In:

Tractors Pulled:

Company:

Phone:

Address

City

State

Supervisor

Date From

Date To

Reason for leaving:

Wage/Salary

Position Held:

State(s) Drove In:

Tractors Pulled:

Company:

Phone:

Address

City

State

Supervisor

Date From

Date To

Reason for leaving:

Wage/Salary

Position Held:

State(s) Drove In:

Tractors Pulled:

Company:

Phone:

Address

City

State

Supervisor

Date From

Date To

Reason for leaving:

Wage/Salary

Position Held:

State(s) Drove In:

Tractors Pulled:

Company:

Phone:

Address

City

State

Supervisor

Date From

Date To

Reason for leaving:

Wage/Salary

Position Held:

State(s) Drove In:

Tractors Pulled:

Pre-Application For Employment

Mike Lowrie Trucking, Inc., Mike Lowrie Transport, Inc., MC Transport Services, Inc.

P.O. Box 207Dixon, Ca 95620(707) 678-3018

Items in red are required.

Date of Application: 11/24/2024

Have you ever had a DUI, and has your driver’s license ever been suspended, revoked, or denied and if so, explain below.

Accident Record for the past 5 years

Traffic Convictions and Forfeitures for the past 3 years

To be read and signed by applicant

Mike Lowrie Trucking, Inc., Mike Lowrie Transport, Inc., MC Transport Services, Inc.

Employment History

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P.O. Box 207
Dixon, Ca 95620
(707) 678-3018