Modern Piano Moving
Online Application Driver Position
Step 1 of 11
 

 

Please provide us your contact information
* Position Applying for:
     
* Social Security Number:     in this form (XXXXXXXXX)
* Year of Birth:
* Phone Number:     in this form (XXXXXXXXXX)
* Email Address:


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 2 of 11
 

 

Please list your last 3 years of residency
* Current Address:
* City: * State: * Zip:
* Years: * Months:
 
Previous Address:
City: State: Zip:
Years: Months:
 
Previous Address:
City: State: Zip:
Years: Months:


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 3 of 11
 

 

Eligibility
* Do you have the legal right to work in the US?      
* Can you provide proof of age? 
Please provide your height ft inches
Please provide your weight lbs
* Have you worked for this company before?       Where?
If Yes: Dates: From   To     
Rate of Pay  / yr    in this form (XXXXXXXXXX)     Position       Reason for Leaving      
 
Region
Please choose a region that you would desire
* Are you now employed?      If not, how long since leaving last employment?   years.    
Who referred you to us?      * Rate of pay expected  / yr    in this form (XXXXXXXXXX)
* Have you ever been bonded?       Name of Bonding Company 
* Have you ever been convicted of a felony?   
If, Yes, please explain. (Conviction not an automatic bar to employment).  
* Is there any reason you might be unable to perform the functions of the job for which you have applied? 
If Yes, Explain. 


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 4 of 11
 

 

List last 3 employers in reverse order starting with the most recent.
* Employer Name:
Date: From (year) To (year)
* City: * State
* Position Held:
* Salary/Wage: / yr    in this form (XXXXXXXXXX)
* Contact Person: Phone #:
* Reason for Leaving:
Were you subject to the FMCSRs while employed?
Was your job designated as a Safety-sensitive function in any DOT-regulated mode subject to the Drug & Alcohol testing requirements of 49 CFR PART 40?
 
Employer Name:
Date: From (year) To (year)
City: State
Position Held:
Salary/Wage: / yr    in this form (XXXXXXXXXX)
Contact Person: Phone #:
Reason for Leaving:
Were you subject to the FMCSRs while employed?
Was your job designated as a Safety-sensitive function in any DOT-regulated mode subject to the Drug & Alcohol testing requirements of 49 CFR PART 40?
 
Employer Name:
Date: From (year) To (year)
City: State
Position Held:
Salary/Wage: / yr    in this form (XXXXXXXXXX)
Contact Person: Phone #:
Reason for Leaving:
Were you subject to the FMCSRs while employed?
Was your job designated as a Safety-sensitive function in any DOT-regulated mode subject to the Drug & Alcohol testing requirements of 49 CFR PART 40?


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 5 of 11
 

 

Accident record for past 3 years or more. If none, enter NONE.
* Dates Nature of Accident Fatalities Injuries Hazardous spills


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 6 of 11
 

 

Traffic convictions and forfeitures for past 3 years
(other than parking violations) If none, enter NONE.
* Location Date Charge Penalty


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 7 of 11
 

 

License Privileges
A. * Have you ever been denied a license permit or privilege to operate a motor vehicle?  
B.* Has any license permit or privilege ever been suspended or revoked?  
If the answer to either A or B is yes, please explain:  


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 8 of 11
 

 

License Qualifications
List all driver licenses or permits held in the past 3 years
* State * License No. * Type * Exp. Date


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 9 of 11
 

 

Mechanical Experience
Do you have any mechanical experience:
If YES, Please explain:
 
 
Driving Experience
Class of Equipment Type Dates-From/To Approx. No. of Miles/Total
Straight Truck
Tractor & Semi Trlr.
Tractor-Two Trailers
Tractor-Three Trlrs.
Other  


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Step 10 of 11
 

 

Special Courses and Awards
List states opereated in for the last 5 years:
Show special courses or training that will help you as a driver:
Which Safe Driving Awards do you hold and from whom? 
 
Experience and Qualifications
Show any trucking, transportation or other experience that may help in your work for this company.
List any additional courses/training other the shown elsewhere in this application.
List special equipment or technical materials you can work with (other than those already shown).
As a driver/piano mover, what can you offer Modern Piano Moving that others may not have to offer?
Describe your past employment experience as it relates to Modern Piano Moving.
* Where do you want/expect to be in five years?
Have you discussed with your family the effects this job will have on your home/family life if you are away from home for extended periods of 2 - 3 weeks at a time?


     800.737.5600             992 Highway D  Sullivan, MO  63080
Modern Piano Moving
Online Application
Final Step
 

 

Education
Highest Grade Completed:       High School:      College: 
* Name of Last School Attended:    * City:    * State:
 
TO BE READ AND AGREED TO BY APPLICANT
I authorize you 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, 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 understand, also, that I am required to abide by all rules and regulations of Modern Piano Moving.

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.

 

Submitting this form 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.


     800.737.5600             992 Highway D  Sullivan, MO  63080