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Driver Employment Application
Basic Information
All fields are required*
Driving License & Experience
Employment History & Education
Upload Documents
Terms & Conditions
Personal Information
First Name
Last Name
Phone
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?
