Driver Application

Applications

Fill out and submit Driver Application Form Below

"*" indicates required fields

COMPANY NAME*

Location: Region/District/Branch

COMPANY ADDRESS*

Street Address City State ZIP Code

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 related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only II 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 (0). 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 cannot agree on the accuracy of the information."

Signature (Name)*

Date*

NAME*

First Middle Last

Social Security Number

Phone

Hire Date

Date

ADDRESS*

Street Address City State ZIP Code

PAST 3 YEAR RESIDENCY

Residency

Street Address City State ZIP Code

Number Of Years

Current Residency

Street Address City State ZIP Code

Number Of Years

Residency

Street Address City State ZIP Code

Number Of Years

Employment History

(Use Additional Employment History Information form if necessary)

All applicants wishing to drive in Interstate commerce must Provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten year employment record).

You are required to list the complete mailing address: street number and name, city state and zip code.

CURRENT OR LAST EMPLOYER: Name*

Phone Number

Address*

Street Address City State ZIP Code

Position Held*

From*

To*

Reasons for Leaving*

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?*

Yes

Was your job designated as as safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

Yes

*ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason

SECOND LAST EMPLOYER: Name*

Phone Number

Address*

Street Address City State / Province / Region ZIP / Postal Code

Position held*

From*

To*

Reasons for Leaving*

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?*

Yes

Was your job designated as as safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

Yes

*ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason

THIRD LAST EMPLOYER: Name*

Phone Number

Address*

Street Address City State / Province / Region ZIP / Postal Code

Position held*

From*

To*

Reasons for Leaving*

Were you subject to the Federal Motor Carrier Safety Regulations** while employed?*

Yes

Was your job designated as as safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

Yes

*ACCOUNT FOR PERIOD BETWEEN JOBS - Include dates (month/year) and reason

*Any gaps in employment and/or unemployment must be explained.

**The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Experience and Qualification

Driving Experience

If no driving experience within the last 3 years - check here

No Driving Experience

CLASS OF EQUIPMENT: Straight Track

TYPE OF EQUIPMENT (Check all the applies)

Van

Reefer

Tank

Flat

FROM

APPROXIMATE NUMBER OF MILES

CLASS OF EQUIPMENT: Tractor & Semi-Trailer

TYPE OF EQUIPMENT (Check all the applies)

Van

Reefer

Tank

Flat

FROM

APPROXIMATE NUMBER OF MILES

CLASS OF EQUIPMENT: Tractor -Two Trailers

TYPE OF EQUIPMENT (Check all the applies)

Van

Reefer

Tank

Flat

FROM

APPROXIMATE NUMBER OF MILES

CLASS OF EQUIPMENT: Tractor -Three Trailers

TYPE OF EQUIPMENT (Check all the applies)

Van

Reefer

Tank

Flat

FROM

APPROXIMATE NUMBER OF MILES

CLASS OF EQUIPMENT: Motorcoach - School Bus (> 8 passengers)

FROM

APPROXIMATE NUMBER OF MILES

CLASS OF EQUIPMENT: Motorcoach - School Bus (> 15 passengers)

FROM

APPROXIMATE NUMBER OF MILES

Other Equipment

TYPE OF EQUIPMENT (Check all the applies)

Van

Reefer

Tank

Flat

N/A

FROM

APPROXIMATE NUMBER OF MILES

Accident History (3 years)

If no accidents within the last 3 years - check here

No Accidents

DATE

NATURE OF ACCIDENT (head-on, rear-end, upset, ets

NUMBER OF FATALITIES

NUMBER OF INJURIES

HAZARDOUS MATERIAL SPILL

YES

DATE

NATURE OF ACCIDENT (head-on, rear-end, upset, ets

NUMBER OF FATALITIES

NUMBER OF INJURIES

HAZARDOUS MATERIAL SPILL

YES

DATE

NATURE OF ACCIDENT (head-on, rear-end, upset, ets

NUMBER OF FATALITIES

NUMBER OF INJURIES

HAZARDOUS MATERIAL SPILL

YES

Traffic Convictions and Forfeitures (3 years)

If no traffic convictions and/or forfeitures within the last 3 years - check here

No traffic convictions and/or forfeitures

DATE

VIOLATIONS (other than violations involving parking only)

STATE OF VIOLATION

PENALTY (forfeited bond, collateral and/or points)

License Information

Section 383.21 FMCSR stales No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

STATE*

LICENSE NUMBER*

EXPIRATION DATE*

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

Has any license, permit, or privilege been suspended or revoked?

Yes

If yes, give details

Upload Resume

Drop files here or

Max. file size: 256 MB.

Applicant Certification

This certifies that this application was completed by me, and all the entries on it and information in it are true and complete to the best of my knowledge

Signature (Name)*

Date*

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Applications

Fill out and submit Driver Application Form Below