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Job Application

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

Name *
Can you provide proof of age?	Yes No

Contact Details

Cell phone *
Email Address
Where did you hear about this opportunity?

List your address of residency for the past 3 years:

Current Address	Street, City, State, Zip
How long?
Previous Address 1:	Street, City, State, Zip
How long?
Previous Address 2:	Street, City, State, Zip
How long?
Previous Address 3	Street, City, State, Zip
How long?

Qualifications

Do you have the legal right to work in the United States?	Yes No
Have you worked for this company before?	Yes No
If so, where?
Date Range
Position
Reason for leaving
Are you currently employed?	Yes No
If not, how long since last employment?
Who referred you?
Have you ever been convicted of a felony?	Yes No
If so, please explain why
Is there any reason you might be unable to perform the functions of the job for which you have applied for as described in the job description? If yes, explain.

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing addresses, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years of information on those employers for whom the applicant operated such vehicle. (Total of 10 years) (NOTE: list employers in reverse order starting with the most recent.) Any gaps in employment history must be explained. If work history doesn’t meet the 10 year requirement, please explain.

Employer 1 Name
Employer 1 Address	Street, City, State, Zip
Employer 1 Contact Person
Were you subject to the **FMCSRs while employed?	Yes No
Was your job designed as a safety-sensitive function in any DOT-Regulated mode subjected to Drug or Alcohol testing requirements of 49CFR Part 40?	Yes No
Date Range
Position Held
Salary/Wage
Reason For Leaving
Employer 2 Name
Employer 2 Address	Street, City, State, Zip
Employer 2 Contact Person
Were you subject to the **FMCSRs while employed?	Yes No
Was your job designed as a safety-sensitive function in any DOT-Regulated mode subjected to Drug or Alcohol testing requirements of 49CFR Part 40?	Yes No
Date Range
Position Held
Salary/Wage
Reason for leaving
Employer 3 Name
Employer 3 Address	Street, City, State, Zip
Employer 3 Contact Person
Were you subject to the **FMCSRs while employed?	Yes No
Was your job designed as a safety-sensitive function in any DOT-Regulated mode subjected to Drug or Alcohol testing requirements of 49CFR Part 40?	Yes No
Date Range
Position Held
Salary/Wage
Reason for Leaving
Employer 4 Name
Employer 4 Address	Street, City, State, Zip
Employer 4 Contact Person
Were you subject to the **FMCSRs while employed?	Yes No
Was your job designed as a safety-sensitive function in any DOT-Regulated mode subjected to Drug or Alcohol testing requirements of 49CFR Part 40?	Yes No
Date Range
Position Held
Salary/Wage
Reason for leaving
Employer 5 Name
Employer 5 Address	Street, City, State, Zip
Employer 5 Contact Person
Were you subject to the **FMCSRs while employed?	Yes No
Was your job designed as a safety-sensitive function in any DOT-Regulated mode subjected to Drug or Alcohol testing requirements of 49CFR Part 40?
Date Range
Position Held
Salary/Wage
Reason for leaving
Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding. *The Federal Motor Carrier Regulations (FMCSRs) 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 GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record

Please fill in for the past 3 years or more. If none, write none.
Accident Date 1
Nature of Accident (Head-on, Rear-end, Upset, Etc.)
Fatalities
Injuries
Hazardous Material Spill

Accident Date 2
Nature of Accident (Head-on, Rear-end, Upset, Etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident Date 3
Nature of Accident (Head-on, Rear-end, Upset, Etc.)
Fatalities
Injuries
Hazardous Material Spill

Traffic Convictions

And forfeitures for the past 3 years (other than parking violations). If none, write none.
Location 1
Date
Type
Expiration Date

Location 2
Date
Type
Expiration Date

Location 3
Date
Type
Expiration Date

Experience and Qualifications – Driver

List all driver licenses or permits held in the past 3 years
License State 1
License Number
Type/Class
Expiration Date

License State 2
License Number
Type/Class
Expiration Date

License State 3
License Number
Type/Class
Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Yes No
B. Has any license, permit or privilege ever been suspended or revoked?	Yes No
If the answer to either A or B is yes, give details:

Driving Experience

Class of Equipment: Straigt Truck	Yes No
Type of Equipment
Date Range
Approximate number of miles (total)

Class of Equipment: Tractor and Semi-Trailer	Yes No
Type of Equipment
Date Range
Approximate number of miles (total)

Class of Equipment: Tractor – Two Trailers	Yes No
Type of Equipment
Date Range
Approximate number of miles (total)
List all states operated in for last five years:

Experience and Qualifications – Other

Show any trucking, transportation or other experience that may help in your work for this company.
List courses and training other than shown elsewhere in this application (Awards for safe driving may also be included):
List special equipment or technical materials you can work with (other than those already shown):

Education

Highest Grade Completed:
Last School Attended (Name, City, State):
TO BE READ AND SIGNED BY APPLICANT I authorize Compass Well Services 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, school, 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 by all rules and regulations of Compass Well Services, LLC. 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 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.
	* By checking this I agree that I have read the above statement and agree to the authorization. * This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.