Call Us: 800-236-2936

Call Us: 800-236-2936

 

Application

Application
Include street, city, state and zip
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 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.
Type your name here.
Name
Name
First Name
Middle Name
Last Name

ADDRESS INFORMATION

please list addresses for the last 3 years

Include street, city, state, and zip
Include street, city, state, and zip
Include street, city, state, and zip
Include street, city, state, and zip

EMPLOYMENT HISTORY

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.

Include street, city, state, and zip
Were you subject to the Federal Motor Carrier Safety Regulations** 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?

Second Employer

Include street, city, state, and zip
Were you subject to the Federal Motor Carrier Safety Regulations** 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?

Third Employer

Include street, city, state, and zip
Were you subject to the Federal Motor Carrier Safety Regulations** 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?
*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

Straight Truck
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Tractor & Semi-Trailer
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Tractor - Two Trailers
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Tractor - Three Trailers
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Motorcoach - School Bus (more than 8 passengers)
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Motorcoach - School Bus (more than 8 passengers)
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Include equipment type: Van, Reefer, Tank, Flat, N/A
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles
Enter dates you drove this vehicle type OR number of miles

Accident History (3 years)

(head-on, rear-end, upset, etc.)
Haz-Mat Spill Acc 1?
(head-on, rear-end, upset, etc.)
Haz-Mat Spill Acc 2?
(head-on, rear-end, upset, etc.)
Haz-Mat Spill Acc 3?

Traffic Convictions and Forfeitures (3 years)

month/year
Other than violations involving parking only
Forfeited bond, collateral and/or points
month/year
Other than violations involving parking only
Forfeited bond, collateral and/or points
month/year
Other than violations involving parking only
Forfeited bond, collateral and/or points

License Information

Section 383.21 FMCSR states “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.

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

Applicant Certification

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.

Type your name here.