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DRIVER APPLICATION FOR EMPLOYMENT |
| In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or non-job related disability. |
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First Name: |
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Middle Initial: |
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| Last Name: |
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| Cell Number: |
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| Telephone Number: |
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| Email: |
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| Birth Date |
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| CDL Driver License #: |
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| CDL Driver License State: |
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| CDL Driver License Exp MMYY |
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| Social Security: |
-125200 |
Current Address
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| Street Address: |
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| Address Line 2: |
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| City: |
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| State: |
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| Zipcode: |
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Previous Address
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| Previous Address (if less than 3 years at current address) |
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| Street Address: |
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| Address Line 2: |
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| City: |
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| State: |
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| Zipcode: |
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| How Many Years at Previous Address |
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| CLASS OF EQUIPMENT |
TYPE OF EQUIPMENT
(VAN/TANK/FLAT/ETC) |
TOTAL YEARS EXPERIENCE |
| HOW MANY YEARS OF FLATBED EXPERIENCE? |
| TRACTOR & SEMI TRAILER |
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| OTHER |
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| TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 3 YEARS (NON-PARKING VIOLATIONS)?…………… |
| LOCATION |
DATE (MM DD YYYY) |
CHARGE |
PENALTY |
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| ACCIDENT RECORD FOR PAST 3 YEARS?…………… |
DATE OF LAST 3
ACCIDENTS
MM DD YYYY |
NATURE OF ACCIDENT
(HEAD ON, REAR-END, ETC.) |
ANY FATALITIES
(Yes,No) |
ANY INJURIES |
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| 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 revolked? |
| IF THE ANSWER TO EITHER A OR B ABOVE IS YES, GIVE DETAILS HERE: |
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| C. Have you ever tested positive or refused to be tested on any pre-employment drug or alcohol test at the time of applying for Safety Sensitive Transportation work covered by DOT agency drug or alcohol testing rules, but were never hired? |
| IF YES, YOU MUST SUPPLY COMPLETION OF RETURN TO DUTY PROCESS. |
EMPLOYMENT RECORD |
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NOTE: DOT REQUIRES ALL EMPLOYERS FOR THE PREVIOUS 3 YEARS AND ALL CDL EMPLOYMENT FOR AN ADDITIONAL 7 YEARS (10 YEARS TOTAL) |
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| POSITION HELD: |
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FROM (MMYYYY): |
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TO (MMYYYY): |
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| WERE YOU SUBJECT TO THE FMCSR’S DOT REGULATIONS? |
| POSITION HELD: |
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FROM (MMYYYY): |
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TO (MMYYYY): |
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| WERE YOU SUBJECT TO THE FMCSR’S DOT REGULATIONS? |
| POSITION HELD: |
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FROM (MMYYYY): |
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TO (MMYYYY): |
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| WERE YOU SUBJECT TO THE FMCSR’S DOT REGULATIONS? |
| POSITION HELD: |
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FROM (MMYYYY): |
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TO (MMYYYY): |
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| WERE YOU SUBJECT TO THE FMCSR’S DOT REGULATIONS? |
| POSITION HELD: |
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FROM (MMYYYY): |
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TO (MMYYYY): |
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| WERE YOU SUBJECT TO THE FMCSR’S DOT REGULATIONS? |
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