1-800-879-3152
info@thriftypropane.com

Driver Application Form

Thrifty Propane

PO BOX 2018
Medina, OH 44258

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TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other 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 the Company.

"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 current/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 cannont agree on the accuracy of the information."

In lieu of Signature, please provide the following:
Full Legal Name:		Numeric 4 Digit PIN:	(ex. 1234)

First Name: Middle Name: Last Name:
Date of Birth:	/ / (mm/dd/yyyy)
Contact Phone:	(ex. 123-456-7890)	Email:
Driver's License #		License State

Address:
City:		State:		County:		ZIP:

Please check the appropriate box
Do you have a CDL?	YesNo	If yes:	AB	?
Do you have hazmat endorsement on CDL?	YesNo
Do you have tanker endorsement on CDL?	YesNo
Do you have experience related to propane, such as natural gas or fuels?	YesNo
Are you over the age of 25?	YesNo
How many years of driving experience do you have?	1-34-6> 6
Do you have Propane Delivery Experience (Bobtail)?	YesNo
Do you have Fuel Oil Home Delivery Experience?	YesNo
Do you have Tank Setting Experience (Service)?	YesNo
Do you have Propane Transport Experience Experience (Tanker/Tractor)?	YesNo
Have you had more than 2 violations on License in the past 3 years?	YesNo