Driver Application

Driver's Application for Employment

* Indicates required field

Applicant Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

How long at this address? *

Email *

Phone Number *

Date of Application *

Do you have the legal right to work in the United States? *

Can you provide proof of age? *

Have you worked for the Company before? *

Are you now employed? *

If not, how long since leaving last employment? *

Is there any reason you might be unable to perform the functions of the job for which you have applied? *

If yes, explain if you wish. *

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.
Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide and additional 7 years' information on those employers for whom the applicant operated such vehicle.
(NOTE: List employers in reverse order starting with the most recent.)

Employer Name (Most Recent) *

Date From (Month/Year) *

Date To (Month/Year) *

Employer Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Person *

Position Held *

Reason For Leaving *

Contact Phone Number *

Salary/Wage *

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 and Alcohol testing requirements of 49 CFR Part 40? *

Employer Name *

Employer Address *

Line 1

Line 2

City

State

Zip Code

Country

Date From (Month/Year) *

Contact Person *

Position Held *

Reason For Leaving *

Date To (Month/Year) *

Contact Phone Number *

Salary/Wage *

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 and Alcohol testing requirements of 49 CFR Part 40? *

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
The Federal Motor Carrier Safety Regulations (FMCSRs) 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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record

For Past 3 Years or More. If None, write note.

Date of Last Accident *

Nature of Accident *

Fatalities *

Injuries *

If other, please describe. *

Hazardous Material Spill *

Next Previous *

Nature of Accident *

Fatalities *

Injuries *

If other, please describe. *

Hazardous Material Spill *

Traffic Convictions

And Forfeitures for the Past 3 Years (other than parking violations) If None, select none.

Location *

Date *

Charge *

Penalty *

Experience and Qualifications

Driver licenses or permits held in the past 3 years.

State *

License# *

Class *

Endorsement(s) *

Expiration Date *

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, Give Details Here. *

Driving Experience

Class of Equipment *

Type of Equipment *

Date From (M/Y) *

Date To (M/Y) *

Approx. No. of Miles (Total) *

List States Operated in For Last Five Years *

Special Courses that will help you as a driver. *

Which Safe Driving Awards do you hold and from whom? *

Experience and Qualifications

List any trucking, transportation or other experience that may help in you work for this company. *

List courses and training other than shown elsewhere in this application. *

List special equipment or technical materials you can work with (other than those already listed). *

Education

Highest Grade Completed *

High School *

College *

Name of Last School Attended *

City *

State *

Acknowledgement By Applicant

This 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.

Applicant Full Name *

Application Date *

Resume *

Max file size: 20MB

Motor Vehicle Record *

Max file size: 20MB

Certifications *

Max file size: 20MB

Submit

In Compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

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 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 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.

Driver's Application for Employment

Employment History

Accident Record

Traffic Convictions

Experience and Qualifications

Driving Experience

Experience and Qualifications

Education

Acknowledgement By Applicant

To Be Read and Signed by Applicant

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