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CDL Driver Application

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Position(s) Applied For

Full Name

Social Security Number

Date of Birth

Can you provide proof of age?YesNo

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

Have you ever been convicted of a felony?YesNoIf yes, please explain fully. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Is there any reason you might not be able to perform the functions of the job for which you are applying (as described in the attached job description)?YesNo

If yes, please explain

Current Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

How Long?

Previous Address 1

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

How Long?

Previous Address 2

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

How Long?

Previous Address 3

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

How Long?

Have you worked here before?YesNo

If yes, where?

Date (from)

Date (to)

Rate of Pay

Position

Reason for Leaving

Employment History: All driver applicants for driving in interstate commerce must provide the following information on all employers during the preceding 3 years. Please list complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle * in intra- or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

Please list employers in reverse order starting with the most recent

Employer 1

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

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 a quantity requiring placarding.
The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle that: (1) weighs or has a GVWR of 10,001 lbs. or more (2) is designed or used to transport more than 6 passengers (including the driver), or (3) is of any size an is used to transport hazardous in a quantity requiring placarding.

Employer 2

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

Employer 3

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

Employer 4

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

Employer 5

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

Employer 6

Employer Name

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Were You subject to the FMCSRs while employed?YesNo

Date (from)

Date (to)

Position

Salary/Wage

Reason for Leaving

Was your job designated as a safety-sensitive function in any DOT- regulated mode, subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNo

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

Last Accident

Nature of Accident

Fatalities/Injuries

Haz-Mat Spill

Nature of Accident

Fatalities/Injuries

Haz-Mat Spill

Next Previous

Nature of Accident

Fatalities/Injuries

Haz-Mat Spill

Next Previous

Nature of Accident

Fatalities/Injuries

Haz-Mat Spill

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

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Driver Experience & Qualifications: Please list all driver licenses or permits held in the past 3 years.

State

License Number

Type

Exp. Date

State

License Number

Type

Exp. Date

State

License Number

Type

Exp. Date

State

License Number

Type

Exp. Date

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

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

If the answer to either A or B is YES, please give details

Please list the states you've operated in for the last 5 years

Education

Highest Grade Completed

Last School Attended