Commercial Driver Application

Please enable JavaScript in your browser to complete this form.

Commercial Driver Application For Employment

Company Name

Address

Address Line 1

City

State

Zip Code

Name: *

First

Last

Date:

Applicant Information

Current Address:

Address Line 1

Address Line 2

City

State

Zip Code

Position Appling For:

Who Referred You:

Employment Desired

Full Time
Part Time
Seasonal

Rate of Pay Expected:

Have You Ever Worked For This Company Before?

Yes*
No

*If Yes, When?

Where?

Rate of Pay:

Position:

Reason For Leaving:

Name of Any Relatives Working at This Company:

Are You Currently Employed? If Not, How Long Since Last Employment?

Education

Select The Highest Grade Completed (1-12)

Selected Value: 1

College: (1-4)

Selected Value: 1

HISTORY a Position

Last School Attended:

Address:

Address Line 1

City

State

Zip Code

Military Service

Have You Ever Served In The U.S. Armed Forces?

If Yes, Which Branch?

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

Are You Currently Serving in The Military Reserves?

Are You Currently Serving in The National Guard?

General

Have You Ever Been Bonded?

Name of Bonding Company:

Have You Ever Been Convicted of a Felony? (If yes, not automatically disqualified)

Driver Experience and Qualifications:

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

Date of Birth:

Social Security Number:

Physical History:

The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.

Date of last Department of Transportation prescribed examination:

Can You Provide a Copy?

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:

1) 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?

2) 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?

3) 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?

Name: *

First

Last

Witness: *

First

Last

DRIVER’S LICENSE INFORMATION

Drivers Licenses held in the past 3 years must be shown

State (List All):

License Number (List All):

Type (List All):

Expiration Date (List All):

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?

C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? If you answered “Yes” to A, B, or C, attach a statement giving details.

DRIVING EXPERIENCE

Class of Equipment:

Straight Truck
Tractor & Semi-Trailer
Twin
Other

Type of Equipment (Van, Tank, Flat, etc.):

Dates (List From-To)

Approximate Total Miles:

List states operated in during the last five years:

List special courses or training that will help you as a driver:

List safe driving awards held and who awards were presented by:

ACCIDENT HISTORY

Accident Review for the past 3 years (attach a separate sheet of paper if more space is needed).

Dates (List All)

Nature of Accident (Head-On, Rear-End, Upset, etc)

# Fatalities:

# Injuries:

# Vehicles Towed:

Citations Issued?

MOTOR VEHICLE DRIVING RECORD (MVR)

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

Date:

Location:

Charge:

Penalty:

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 three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained. Start with the last or current position, including any military experience, and work back (Attach separate sheet if necessary.) You are required to list the complete mailing address: street number, city, state and zip code.

Current Employer:

Supervisors Name:

Address:

Address Line 1

City

State

Zip Code

Phone:

Position Held:

Dates:

Salary:

Reason For Leaving:

Previous Employer:

Supervisors Name:

Address:

Address Line 1

City

State

Zip Code

Phone:

Position Held:

Dates:

Salary:

Reason For Leaving:

Previous Employer:

Supervisors Name:

Address:

Address Line 1

City

State

Zip Code

Phone:

Dates:

Salary:

Reason For Leaving:

APPLICANT MUST READ AND SIGN

I certify that I have read and understand all of this employment application. It is agreed and understood that the 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 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.

Name: *

First

Last

Date:

Acknowledgment of Disclosure *

Applicant acknowledges they have read the disclosure of this employment application and agrees to consent to background check.