Employment: Apply Online

916 Blake Street
PO Box 82
Blanchardville, WI 53516
Office: 608.523.4290  Fax: 608.523.4292

J&R Underground, LLC

Employment Application

We are an Affirmative Action/Equal Opportunity Employer.

Personal Information Driving History Physical History Employment History Education / References Skills / Requirements Review & Sign
Personal Information
First Name
Last Name
Physical Address
Number of Years / Months At Current Address:
Mailing Address (if different from above)
Prior Addresses For Past 3 Years (Put each address on a separate line)
Contact Telephone
Email Address
Date Available For Work
The Federal Motor Carrier Safety Regulations (49 CFR 391.21(b)(2)) requires that driver applicants provide their date of birth and social security number.
Date of Birth
Social Security Number
Position Applied For
Date Of Application
Have you ever applied for employment or been employed by J&R Underground LLC?
How did you hear about the Company?
Education And Qualifications: Driver
Driver License #
Expiration Date

Driving Experience
Class Of Equipment Type Of Equipment
(van, tanker, flat, etc.)
Manual Automatic Date From Date To Approximate Number of Miles (Total)
Straight Truck
Tractor & Semi Trailer
Tractor & Two Trailers
Tractor & Tanker
Accident Record for the Three (3) Years Preceding Date of Application
Date Nature of Accident
(Head-on, Rear-end, Roll-over, etc.)
Fatalities Injuries
Most Recent
Violations In The Three (3) Years Preceding Date of Application (excluding parking violations)
Location Date Convictions: Forfeited, Bond or Collateral Penalty
a. Have you ever had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended?
If the answer to “a” is yes, please explain by providing a statement of circumstances.
a. Have you ever been convicted or been on probation for DWI or DUI?
If the answer to “b” is yes, please explain by providing a statement of circumstances.
Physical History
The Federal Motor Carrier Safety Regulations (49 CFR 391 Subpart E) require that all driver applicant pass certain medical examinations before they are hired to drive a motor vehicle.
Date of last Department of Transportation medical examination:
Can you provide a copy?
Alcohol And Controlled Substances Statement
The Federal Motor Carrier Safety Regulations (49 CFR 40.25) requires all persons applying for a driving position requiring a commercials driver’s license to answer the following questions:
1. Within the last two (2) years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer?
2. Within the last two (2) years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer?
Employment History
The Federal Motor Carrier Safety Regulations (49 CFR 391.21) requires 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. You are required to list the complete mailing address, including: street number, city, state, zip, and complete all other information and questions.
Current Employer Name
Position Held
May we contact this employer prior to hiring?
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
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?
School Name & Location Course Of Study Years Of Study Graduate Degree / Diploma
High School
List three persons familiar with your work record and/or abilities. Do not include relatives.
Name Address Phone Years Known
Job Related Skills & Requirements
Only U.S. citizens or those individuals who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, provide genuine documentation establishing your identity and eligibility to be legally employed in the United States?
Are you willing to take a drug test if required as part of your application?
Are you willing to comply with all applicable federal and state regulations/requirements related to obtaining and/or retaining a valid CDL Driver’s License?
Have you ever been convicted of a felony?
Have you had safety training?
Are you willing to work overtime?
Are you willing to travel overnight as needed?
Fair Credit Reporting Act Disclosure Statement

In accordance with the provisions of the Fair Credit Reporting Act (Public La 91-508) as amended by the Consumer Credit Reporting Act of 1996. I have been informed the Company will procure a motor vehicle report (MVR), criminal background check and reference checks, all of which are defined as a consumer report regarding my driving and background record to determine my suitability for work at the Company.

I understand that I have the rights to request, in writing, information pertaining to the nature and scope of the inquiry and a written summary of my rights under the Fair Credit Reporting Act. I understand that I may have additional rights under applicable state and federal laws.

I hereby authorize the Company to obtain this information and release and hold harmless any person, firm, or entity that discloses such information in accordance with this authorization. This authorization shall remain on file and shall serve as ongoing authorization for the Company to procure a motor vehicle report (MVR) and a criminal check which is defined as a consumer report at any time during my employment period. Any copy of this authorization shall have the same authority as the original.

I certify and guarantee that all statements made on this application are true and complete to the best of my knowledge and without mental reservations. I understand that falsification of this application may result in my not being considered for employment or, in the event I become employed by The Company in my dismissal, regardless of when such falsification is discovered.

By typing my name below and clicking “Submit”, I certify 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.

Leave this blank:


phone Contact Us
Toll Free 1.866.370.2243 • Office: 608.523.4290 • Fax: 608.523.4292 • e-mail: info@jrundergroundllc.com