Driver Application of Employment

 

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 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.

arrow&v
arrow&v
arrow&v
arrow&v
Can you perform, with or without reasonable accommodation, the essential function ofthe job?

Employment History

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v

^Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in quantity requiring placarding.

+The Federal Motor Carrier Safety Regulations (FMCSRs) 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 lbs. or more (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record: for the past 3 years or more. If none, write NONE.

Traffic Convictions and forfeitures for the past 3 years (other than parking violations). If none, write NONE

Experience and Qualifications - Driver: Driver licenses or permits held in the past 3 years.

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?

Driving Experience: check Yes or No

Class of Equipment

Straight Truck

Type of Equipment

Dates From / To_______________________

arrow&v

Approx. No. of Miles (total)

Tractor and Semi-Trailer
arrow&v
Tractor - Two Trailers
arrow&v
Tractor - Three Trailers
arrow&v
Motorcoach - School Bus (+8 passengers)
arrow&v
arrow&v
arrow&v
arrow&v
Upload File

Thank you for applying!

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street, city, state, and zip code. 

Applicants to drive a commercial motor vehicle^ in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with the most recent. Add another sheet as necessary.)