Driver application form

DRIVER APPLICATION FORM

I authorize you to make such investigations and inquiries of my personal, employment, financial medical history and or any and all 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, school, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company. 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 46 CFR 391.23(d) and (e).

I understand that I have the right to:

Review information provided by current and or 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

Have a rebuttal statement attached to the alleged erroneous information, and if the previous employer(s) and I cannot agree on the accuracy of the information

Past 3 Year Residency

2nd Residency Address

3rd Residency Address

Employment History

Current /Last Employee

All applicants wishing to drive the interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of 10 year employment record)

You are required to list the complete mailing address: street number and name, city, state, and zip code for all of the below employment records

Second To Last Employee

Third To Last Employee

EXPERIENCE AND QUALIFICATIONS

Any gaps in employment from the following page MUST be accounted for and explained.*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 or 10,001 pounds or more (2) is designed or used to transport more than 8 passengers (including the driver) for compensation (3) is designed or used to transport more than 15 passengers, including the driver, and is not used to transport passengers for compensation (4) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

DRIVING EXPERIENCE

 If no Drawing Experience Within 3 Years     

ACCIDENT HISTORY

WITHIN THE LAST 3 YEARS

IF NO ACCIDENTS WITHIN THE LAST 3 YEARS – 

TRAFFIC CONVICTIONS AND FORFEITURES

WITHIN THE LAST 3 YEARS

  IF NO TRAFFIC CONVICTIONS AND/OR FORFEITURES WITHIN THE LAST 3 YEARS –

LICENSE INFORMATION

Section 383.21 FMCSR stated “No person who operates a commercial motor vehicle shall at any time have more than one drivers license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.

APPLICANT CERTIFICATION

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

ADDITIONAL PERSONAL INFORMATION

We are an equal opportunity employer and commited to excellence through diversity

EDUCATION

REFERENCES