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Driver Application for Employment
*MUST HAVE THREE YEARS OF CDL DRIVING EXPERIENCE**
Name
(Required)
First
Middle Initial
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
(Required)
Phone
(Required)
Maiden Name
(if applicable)
Addresses for the past 3 years:
(Required)
(Click the plus icon to add a new line)
Street or Apt. Number
City
State and Zip
How Long
Add
Remove
Experience and Qualifications – Driver
Driving Experience – Straight Truck
(Click the plus icon to add a new line)
Type of Equipment
From (date) & To
Makes, Models, Manufacturers
Add
Remove
Driving Experience – Tractor Trailer
(Click the plus icon to add a new line)
Type of Equipment
From (date) & To
Makes, Models, Manufacturers
Add
Remove
Driving Experience – Doubles or Triples
(Click the plus icon to add a new line)
Type of Equipment
From (date) & To
Makes, Models, Manufacturers
Add
Remove
Driving Experience – Other
(Click the plus icon to add a new line)
Type of Equipment
From (date) & To
Makes, Models, Manufacturers
Add
Remove
Driver Licenses
(Required)
(Click the plus icon to add a new line)
License Number
State
Type of License
Expiration Date
Add
Remove
Accident Record
(Required)
(Click the plus icon to add a new line)
Location
Dates
Nature of Accident
Fatalities? (Yes or No)
Injuries? (Yes or No)
Add
Remove
Traffic Convictions and Forfeitures for Past 3 Years
(Other than parking) (Click the plus icon to add a new line)
Location
Dates
Violation
Penalty
Add
Remove
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
(Required)
Yes
No
B. Has any license, permit, or privilege ever been suspended or revoked?
(Required)
Yes
No
If the answer to either A or B is yes, give details:
(Required)
Employment Record
Note: DOT requires that employment for at least 3 years and/or Commercial Driving Experience for the last 10 years be shown.
Previous Employers
Employer Name
Actions
Edit
Delete
There are no
Employers.
Add Employer
Maximum number of employers reached.
Have you tested positive or refused to test on a pre-employment drug and alcohol test administered by an employer that you applied to, but did not obtain, safety sensitive transportation work?
(Required)
Yes
No
Have you ever tested positive for drugs and/or alcohol on a test required by the Federal Motor Carrier Safety Regulations?
(Required)
Yes
No
If you answered yes to either of the above questions, have you completed required treatment and return to duty testing as ordered by a certified Substance Abuse Professional (SAP)?
(Required)
Yes
No
Resume
Please upload your Cover Letter and Resume below.
Files to Upload
Drop files here or
Select files
Max. file size: 128 MB.
Disclaimers
Disclaimer
(Required)
I have read and understand the information below.
Please be informed that the above provided information will be used to conduct an investigation into the safety performance history and previous employers will be contacted to provide information. You, as an applicant, have the following rights as listed in 49 CFR 391.23
• The right to review information provided by previous employers.
• The right to have errors in the information corrected by the previous employer and for that previous employer to resend corrected information to your prospective employer.
• The right to have rebuttal statement attached to the alleged erroneous information, if your previous employer and you cannot agree on the accuracy of the information.
If you desire to review this safety performance history provided by a previous employer, you may do so by submitting a written request to us anytime from the date of application submittal or as late as 30 days after becoming employed with us or being notified of denial of employment. Request to make corrections of information provided by previous employers must be submitted to that previous employer. You may report failures of previous employers to correct information or allow for rebuttal via procedures outlined in 49 CFR 386.12.
Applicant Confirmation
(Required)
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.
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