Truck Driver Application Template

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

Yes No

License Class *

License Number *

License expiration date *

Expiration date of DOT physical card *

CDL Endorsements *

None Tanker Doubles/Triples Hazmat X Endorsement TWIC

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? *

Yes No

Branch of service

Please list Dates of enlisment

Enlist date - Discharge date

Did you receive an honorable discharge?

Yes No Other

Have you been to truck driving school?

Yes No

School information

School Name

Dates of attendance

City State / Province

GPA if available Country

School phone number

Area Code Phone Number

Did you graduate?

Yes No

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

Start date *

Date

Ending date *

Date

Employer Name *

City, State *

Employer phone *

Area Code Phone Number

Position Held *

Reason for leaving *

Is this your current employer? *

Yes No

May we contact this employer at this time? *

Yes No

Was this a driving position?

Yes No

Type of truck

Type of trailer

Trailer length

Number of states driven

Full Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Relationship to you *

Phone Number *

Area Code Phone Number

HIGH SCHOOL

Name & City/State of High School

Did you graduate?

Yes No

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 ACCEPT I DO NOT accept

By signing I agree I have read the above statements

General Information

License Information

Employment History

Emergency contact information