Manko CDL Application

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Driver Employment Application
3001 McKinley Ave, Des Moines, IA 50321
866-642-1488
An Equal Opportunity Employer

Driver Employment Application
800 Hayes Dr, Manhattan, KS 66502
785-776-9643
An Equal Opportunity Employer

Driver Employment Application
2005 N Jackson St, Junction City, KS 66441
785-776-9643
An Equal Opportunity Employer

Driver Employment Application
17500 E 22nd Ave, Aurora, CO 80011
303-375-0642
An Equal Opportunity Employer

Which location are you applying for?

First Name*

Middle Name*

Last Name*

Phone*

E-Mail Address*

Date of Birth*

Social Security #*

Position Applied For*

Date Available For Work*

Do you have legal right to work in the United States?*

Yes

No

Previous Three Years Residency

Current Address:

Street:*

City*

State*

Zip*

# of Years at Address*

Mailing Address:

Street:*

City*

State*

Zip*

# of Years at Address*

Previous Address: (If Applicable)

Street:

City

State

Zip

# of Years at Address

Previous Address: (If Applicable)

Street:

City

State

Zip

# of Years at Address

Previous Address: (If Applicable)

Street:

City

State

Zip

# of Years at Address

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

Current License

State*

License #*

Type/Class*

Endorsements*

Expiration Date*

Previous Held Licenses

State

License #

Type/Class

Endorsements

Expiration Date

State

License #

Type/Class

Endorsements

Expiration Date

State

License #

Type/Class

Endorsements

Expiration Date

Driving Experience

Straight Truck

Type of Equipment (Van, Tank, Flat, etc)

Date From

Date To

Approx # of Miles (Total)

Tractor & Semi-Trailer

Type of Equipment (Van, Tank, Flat, etc)

Date From

Date To

Approx # of Miles (Total)

Tractor & 2 Trailers

Type of Equipment (Van, Tank, Flat, etc)

Date From

Date To

Approx # of Miles (Total)

Tractor & Tanker

Type of Equipment (Van, Tank, Flat, etc)

Date From

Date To

Approx # of Miles (Total)

Other

Type of Equipment (Van, Tank, Flat, etc)

Date From

Date To

Approx # of Miles (Total)

Accident Record For The Last 3 Years

Have you had any accidents in the past 3 years?*

Yes

No

Date

Nature of Accident

# Fatalities

# Injuries

Chemical Spill

Date

Nature of Accident

# Fatalities

# Injuries

Chemical Spill

Date

Nature of Accident

# Fatalities

# Injuries

Chemical Spill

Traffic Convictions and Forfeitures For The Past 3 Years
(Other Than Parking Violations)

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

Have you had any traffic convictions or forfeitures in the past 3 years?*

Yes

No

Date Convicted

Violation

State of Violation

Penalty (Forfeited bond, collateral and/or points)

Date Convicted

Violation

State of Violation

Penalty (Forfeited bond, collateral and/or points)

Date Convicted

Violation

State of Violation

Penalty (Forfeited bond, collateral and/or points)

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backwards(attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Current (Most Recent) Employer

Name*

Phone #*

Address*

Position Held*

From*

To*

Reason For Leaving*

Explain Any Gaps In Employment (Include month/year & reason)*

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?*

Yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?*

Yes

No

Second (Most Recent) Employer

Name

Phone #

Address

Position Held

From

To

Reason For Leaving

Explain Any Gaps In Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Yes

No

Third (Most Recent) Employer

Name

Phone #

Address

Position Held

From

To

Reason For Leaving

Explain Any Gaps In Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Yes

No

Education

High School

Name and Location

Course of Study

Years Completed

Did you Graduate?

Yes

No

Details

College

Name and Location

Course of Study

Years Completed

Did you Graduate?

Yes

No

Details

Other

Name and Location

Course of Study

Years Completed

Did you Graduate?

Yes

No

Details

Other Qualifications

Please list any other qualifications that you have and which you believe should be considered.

To Be Read and Signed by Applicant

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior 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. 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 resend 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.

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. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Electronic Signature*

Date*

This field should be left blank

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Locations
Manhattan, KS
Denver, CO
Des Moines, IA

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Manko Headquarters
800 Hayes Dr.
Manhattan, KS 66502
(785) 776-9643
(785) 776-9644 (fax)
[email protected]

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