Truck Driver Application Template

Have you held a VALID US license for the past 36 months?*

YesNo

License Class*

License Number*

License expiration date*

Expiration date of DOT physical card*

CDL Endorsements*

Please list any licenses held in other states for the previous 5 years, include license numbers if you can.

Were you ever in the military?*

YesNo

Branch of service

Please list Dates of enlisment

Enlist date - Discharge date

Did you receive an honorable discharge?

YesNoOther

Have you been to truck driving school?

YesNo

School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry

School phone number

Area CodePhone Number

Did you graduate?

YesNo

Work History: Please list current, or most recent employment first

Start date*

Date

Ending date*

Date

Employer Name*

City, State*

Employer phone*

Area CodePhone Number

Position Held*

Reason for leaving*

Is this your current employer?*

YesNo

May we contact this employer at this time?*

YesNo

Was this a driving position?

YesNo

Type of truck

Type of trailer

Trailer length

Number of states driven

Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Relationship to you*

Phone Number*

Area CodePhone Number

HIGH SCHOOL

Name & City/State of High School

Did you graduate?

YesNo

Official Disclosure Statement:

I certify that I personally completed this application and that all of the information is true and correct to the best of my knowledge.

Authorization to Release Records

I authorize the carrier subscribers indicated on this application to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by these carrier subscribers and hold them harmless of all liability from the release of said information.

I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I agree I have read the above statements

General Information

License Information

Employment History

Emergency contact information