Driver Application - Quality Liquid Feeds

Thank you for choosing QLF Transportation, Inc. as a potential employer. We carefully evaluate each application and select the best qualified candidates for further consideration. Those selected for interviews are contacted by telephone or mail.

General Information

QLF Transportation, Inc. is a subsidiary of Quality Liquid Feeds, Inc. We are a family‐owned corporation with more than 35 years of experience in liquid feed manufacturing. Our Corporate Office, in Dodgeville, Wisconsin, is headquarters for business services, technical services, marketing, sales, order processing, accounting and distribution, as well as human resources.

We have seen continued growth through geographic market expansion, expanded product offerings, improved technical and market services, improved distribution capability and expanded sales force and formation of strategic supplier alliances.

QLF Transportation, Inc. supports marketing and distribution of QLF products throughout the United States and portions of Canada.

General Requirements

While the following is not an all‐inclusive list, at a minimum, in order to be considered for employment, applicants must:

Be a minimum of 21 years of age;
Have a minimum of 1 year verifiable OTR experience
- If applicant has less than a minimum of 1 year verifiable OTR experience, completion of a QLF approved Driving School may be substituted for years of experience at the employer’s discretion. If hired, additional training and orientation would be required as a condition of employment.
Have a minimum of 1 year tanker experience (preferred)
Have no more than two (2) moving violations in the last three (3) years, with no more than one (1) moving violations within any twelve (12) month period
Have no major moving violations;
Possess a valid Class A CDL with tanker endorsement;
Have the ability to pass DOT physical, drug test and other evaluations;
Have NO positive DOT drug or alcohol test of any kind;
Have NO DUI, DWI, alcohol‐related or reckless convictions in the last 7 years, and no more than one in a lifetime;
Have no more than two (2) preventable accidents in the last three (3) years;
Have positive references with stable work history; and
Ability to perform the job requirements with reasonable accommodations.

Instructions for Application

Please complete this application form as completely and truthfully as possible.

When submitting your application, please check that you have all of the following items:

All questions answered; write NONE if it does not apply
Employment Information – begin with your current position and work backwards; make sure there are no gaps in employment

Applicants must alert QLF Transportation, Inc. of any changes that may arise regarding their application, such as a change of contact information, as soon as possible, in order for their application to be processed.

Please direct all inquiries to our Driver/Safety Manager, Tony Fink, at (608) 935‐0915, extension 7. He may also be reached on his cellular phone at (608) 732‐4087.

QLF will contact you for more details following this submission

General Information

Name*

First Last

Middle Initial

Date of Birth*

Current Address*

Street Address City State ZIP Code

Telephone Number*

Length at Current Address*

(Listed in Number of Months)

List Address for the Past Three (3) Years

Past Address #1

Street Address City State ZIP Code

Length at Address

(Listed in Number of Months)

Past Address #2

Street Address City State ZIP Code

Length at Address

(Listed in Number of Months)

Driver License Information

Driver License Number*

Driver License Issuing State*

Driver License Class*

Driver License Endorsement(s)

Driver License Expiration Date*

Tanker Endorsement?

Yes
No

Traffic Convictions and Forfeitures

Do you have any traffic convictions and forfeitures within the past three (3) years (other than parking violations)?*

Yes
No

Please list your traffic convictions and forfeitures

Date	Location	Charge	Penalty

Driver Past Record

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

Yes
No

Have you ever had any licenses, permit or privilege suspended or revoked?*

Yes
No

Have you ever been disqualified for violation(s) of the Federal Motor Carrier Regulations?*

Yes
No

If yes to any questions above, please describe

Do you have a CDL?*

Yes
No

Do you have CMV driving experience?*

Yes
No

Accidents

Have you been involved in an accident in the past three (3) years?*

Yes
No

Date of Accident

Number of Injuries

Number of Fatalities

Location

(City, State)

Accident Description

(i.e. – head‐on, rear end, upset, rollover, etc.)

DOT Regulation Cited

Type of Vehicle Operated

Hazardous Materials Spill?

Yes
No

Date of Accident

Number of Injuries

Number of Fatalities

Location

(City, State)

Accident Description

(i.e. – head‐on, rear end, upset, rollover, etc.)

DOT Regulation Cited

Type of Vehicle Operated

Hazardous Materials Spill?

Yes
No

Driving Experience

Tanker*

Yes
No

Years*

Miles*

From*

To*

Refer*

Yes
No

Years*

Miles*

From*

To*

Van*

Yes
No

Years*

Miles*

From*

To*

Dump*

Yes
No

Years*

Miles*

From*

To*

Flat Bed*

Yes
No

Years*

Miles*

From*

To*

Other

Years*

Miles*

From*

To*

List all states and provinces you have operated a commercial motor vehicle in during the past five (5) years

List any other relevant experience

List any safety awards you have received

List courses and training not listed elsewhere on this application

List special equipment or technical materials you can work with no listed elsewhere on this application

Education

Select the highest grade completed*

Name of Last School Attended

Location of Last School Attended (City, State)

Employment Information

List all periods of employment and unemployment, starting with the most recent. CFR 391.51(b) requires 3 years of history to be verified and 7 subsequent years to be recorded for a total of 10 years of employment history, or to the extent of which the applicant has worked. There should be no gaps in employment; if a gap exists, you must indicate a reason.

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Employer Name

Start Date

Position Held

End Date

Employer Address

Street Address City State ZIP Code

Telephone Number

Contact Person

Were you subject to the FMCSR while employed?

Yes
No

Was the job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substance testing required by 49 CFR Part 40?

Yes
No

Type of Tractor Operated

Type of Trailer Operated

Reason for Leaving

If a gap between employment exists, indicate reason:

Unemployed
Self Employed

Additional Information

Additional information will be requested after review of online application.

CAPTCHA