Commercial Driver Application for Employment

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Company Address

Name
Current Address

If at the above residence less than three years, list below all residences for the past three years. Attach a separate sheet if necessary.

Address
Address
Max. file size: 50 MB.

Type of Employment
Have you worked for this company before?
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Are you currently employed?

Education History

Address

Military Experience

Have you ever served in the U.S. Armed Forces?

Describe any military training received relevant to the position for which you are applying.

Are you currently serving in Military Reserves?
Are you currently serving in National Guard?

General

Have you ever been bonded?
Answer only if a job requirement
Have you ever been convicted of a felony?
Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Driver Experience and Qualifications

The Federal Motor Carrier Safety Regulations 49CFR391.21 (b) (2) required that driver applicants state their date of birth and SS#.
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Physical History

The Federal Motor Carrier Safety Regulations 49CFR391 Subpart E required that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.
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Can you provide a copy?
Have you ever been granted a waiver under section 391.49 of the Federal Motor Company Safety Regulations pertaining to the loss of foot, leg, hand or arm?

Alcohol and Controlled Substance Statement

The Federal Motor Carrier Safety Regulations 49CFR40.25 (j) requires all persons with applying for a driving position requiring a commercial drivers license to answer the following questions:
Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?
Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?
If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

Driver's License Information

Driver's Licenses held in past 3 years must be shown

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?
If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?
Max. file size: 50 MB.

Driving Experience

Class of Equipment
Van, Tank, Flat, etc.
Van, Tank, Flat, etc.
Van, Tank, Flat, etc.
Van, Tank, Flat, etc.

Accident History

Accident Review for the past 3 years (attach a separate file if more space is needed)
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Head-on, rear-end, upset, etc.
Citation Issued?

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Head-on, rear-end, upset, etc.
Citation Issued?
Max. file size: 50 MB.

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Head-on, rear-end, upset, etc.
Citation Issued?

Motor Vehicle Driving Record

Traffic Convictions and Forfeitures for the past 3 years other than parking violations.
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Location

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Location

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Location

Employment Record

The Federal Motor Carrier Safety Regulations 49CFR391.21 require that all applicants wishing to drive a commercial vehicle list all employment for the last 3 years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional 7 years for a total of 10 years. Any gaps in employment must be explained. Start with the last or current position, including any military experience, and work back. Attach a separate file if necessary. You are required to list the complete mailing address.
Supervisor's Name
Address
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Supervisor's Name
Address
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Supervisor's Name
Address
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Max. file size: 50 MB.

Applicant Must Read

I verify that I have read and understand all of this employment application. It is agreed and understood that this employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.

I agree to furnish such additional information information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.
This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.(Required)
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