Ann Arbor Distribution
Ann Arbor Distribution

Employment Opportunities

Delivery Driver Application

Applicant Information

Driver's License Information

Current Address

Previous Addresses (if been at current address less than 3 years)

Position Being Applied For

Ann Arbor
Temporary Part Time Full Time
Are you able to meet attendance requirements of this position? Yes No
Will you work overtime if required? Yes No
If no, please explain:
Have you ever been bonded? Yes No
Answering "yes" to the following question does not constitute an automatic bar to employment - all circumstances will be considered. Failure to disclose convictions found on a criminal report will eliminate me from further consideration of employment.
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime (other than a traffic violation)?
Yes No
If yes, please provide date(s) and details:

Referral Source

Previous Contact with Ann Arbor Distribution

Have you submitted an application here before? Yes No
If yes, give dates and positions:
Have you been employed here before? Yes No
If yes, give dates and positions:
Reason for leaving:


Yes No

Last School Attended

Experience & Qualifications

Drivers licenses held in the past 3 years must be shown
State Class Endorsement(s) Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
Has any license, permit or privilege ever been suspended or revoked? Yes No
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? Yes No

Driving Experience

Class of Equipment Type of Equipment (Van, Tank, etc) From To Approx Total Miles
Straight Truck:
Tractor & Semi-Trailer:
Twin Trailers - LCVs:
List states operated in during last five years:
List special courses or training that will help you as a driver:
List driving awards held and who awards were presented by:

Accident Review for Past 3 Years

  Nature of Accident (Head-On, Rear-End, Overturn, etc) Fatalities Injuries
Last Accident:
Next Previous:
Next Previous:

Traffic Convictions and Forfeitures

List traffic convictions and forfeitures for the past 3 years, other than traffic violations
Location Date Charge Penalty

Employment Record

The U.S. Department of Transportation requires that driver applications show all employment for the past 3 years. They must also show commercial employment for the 7 years immediately preceding this 3 year period.
Start with your last or current position, including military experience, and work back.

Employment History

Explain any gaps in your employment, other than those due to personal illness, injury or disability:

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:


Please give the names of three additional work related references whom we may call. Please do not list relatives. Individuals with no prior work experience may list school or volunteer-related references.
Name Company and Position Held Telephone Years Known

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Ann Arbor Distribution is true, complete and correct.

I expressly authorize, without reservation, Ann Arbor Distribution, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I have regarding Ann Arbor Distribution, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that Ann Arbor Distribution does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

I understand that Ann Arbor Distribution is an "At Will Employer". If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and Ann Arbor Distribution reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are written and signed by Ann Arbor Distribution president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.