Employment Application

Employment Application

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or non-job related disability.

I understand that information I provide regarding current and/or previous employment 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 (c).

I also 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

Driver Information

First
Middle
Last
City
State/Province
Zip/Postal

Previous Addresses

Please enter addresses for the past (3) years.
City
State/Province
Zip/Postal
City
State/Province
Zip/Postal
City
State/Province
Zip/Postal

Work Experience

In accordance with ยง391.21 & .23 of the Federal Motor Carrier Safety Regulations (FMCSR), an applicant must list all previous work experience for the (3) years prior to the date of application, as well as all commercial driving experience for (7) years prior to those three years for a total of 10 years. If you are an owner operator, list carriers leased to. Please list starting with the most recent employer, use the second section if needed.

The Federal Motor Carrier Safety Regulations 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 pounds or more, 2) is designed or used to transport 9 or more passengers, or 3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Current or Last Employer

City
State/Province
Zip/Postal
Include Dates (month/year) and Reason. Any gaps in employment and/or unemployment must be explained.

Second Last Employer

Third Last Employer

Additional Employment

Commercial Driver's License Information

Additional Driver's License(s) in the past 3 years

Collisions

If Yes, please complete the following information for each collision.

Traffic Convictions & Forfeitures

If Yes, please complete the following information for each Conviction and/or Forfeiture.

Driving Experience

List Equipment Type (Van, Tank, Flat, etc.)
List Equipment Type (Van, Tank, Flat, etc.)
List Equipment Type (Van, Tank, Flat, etc.)

Education

General

First & Last Name

Must be Read & Signed by the Applicant

I authorize the carrier to make such inquiries and investigations of my personal, employment, driving, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I agree to abide by the rules and regulations of the carrier as well as the Federal Motor Carrier Safety Regulations. I also agree and understand that if I am selected to drive for the carrier that I will be on a probationary period during which time I may be discharged without recourse.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Applicant Electronic Signature

First
Last
Sending