Motor Vehicle Driver
Application For Employment

Gaubert Oil Company, Inc.
1201 Saint Patrick Hwy. // P.O. Box 310, Thibodaux, LA 70301
985.447.3811 // Fax: 985.447.1614
USDOT Number 360385

In compliance with Federal and State equal opportunity laws, qualified applicant are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status, union affiliation, sexual orientation, the presence of a non-job related medical condition or handicap, or another category protected by law.

Addresses For The Last Three Years

Prior to date of application

General Questions

Education

Elem, High, Tech, College
Elem, High, Tech, College

Driving Licenses For Past (3) Years Prior To Application Date

Complete for each license/permit

Driving Experience In The Operation of Motor Vehicles

Please specify

Accident Record For The Past (3) Years Prior To Application Date

Starting with most recent.
Passenger vehicle, head-on, rear-end, etc.
Starting with most recent.
Passenger vehicle, head-on, rear-end, etc.
Starting with most recent.
Passenger vehicle, head-on, rear-end, etc.

Traffic Convictions & Forfeitures In The Past (3) Years Prior To Application Date

Other than parking.
State
State
State

Employment History

All driver applicants must provide the following information on all work references during the producing three (3) years from the date application is submitted. Those drivers applying to operate a commercial motor vehicle as defined in 383.5 (requiring a CDL) shall also provide ten (10) years of employment history. NOTE: Please list companies in reverse order starting with the most recent and leave no gaps in employment history.

Work History #2

Work History #3

Work History #4

Work History #5

Work History #6