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Driver Employment Application

Basic Information

All fields are required*

Driving License & Experience

Employment History & Education

Upload Documents

Terms & Conditions

  • Basic
  • License
  • Employment
  • Documents
  • Terms

Personal Information

First Name

Last Name

Phone

Email

DATE OT BIRTH

Employment Status

SOCIAL SECURITY #

DATE AVAILABLE FOR WORK

Do you have legal right to work in the United States?

Current Address

Street

City

State

Zip Code

License Information

State Issued

License Number

Type / Class

Endorsements

Expiration Date

Driving Experience

Class Of Equipment

Type Of Equipment (VAN, Tank, Flat etc.)

Date From

Date To

Apx. Number Of Miles

Accident Record For The Past 3 Years

Date Of Accident

Describe the Accident

Traffic Convictions and forfeitures for the past 3 years (Other than parking violations)

Date Of Convicted

Describe the violation

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? If Yes Explain

Has any license, permit, or privilege ever been suspended or revoked?

Employment History

Employer Name

Phone

Address

Your position

From Date

To Date

Reason for leaving

Salary

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Was the job designated as a safety-sensitive function in any Department of Transportation-regulatedmode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

Education

School Name

Location

Course Of Study

Year Completed

Graduate

IDs

Driver License

Max. size: 50.0 MB

Social Security Card

Max. size: 50.0 MB

Terms & Conditions

l authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary for arriving at an employment decision.


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.


ln, the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge, I also understand that lam required to abide by all rules and regulations of the Company.


I understand that the information I provide regarding my current and/or prior 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 39L23.1


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 resend 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.

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.


Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Do you agree to terms and conditions listed above?