Driver Application Form

Equal Opportunity Employer
DRIVER APPLICATION FORM

Talex Trans Inc. | 1500 W 3rd Ave #205 Columbus OH 43212 | 614-305-4566
Driver Information
Name*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Social Security #*
Date of Application*

MonthDayYear
Date
Date Available To Work*

MonthDayYear
Date
Position Applied For*
How Did You Hear About Us?
If Someone Referred You To Us, Please Provide Their Name Below

First NameLast Name
Do you have legal right to work in the United States?*
PREVIOUS THREE YEARS RESIDENCY

Provide us with additional document if more space is needed.
# of years at address*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Click Here for Additional Address Fields
# of years at address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
# of years at address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Includes all licenses held for the past 3 years: provide additional documentation if needed.
State*
License Number*
Class*
Expiration Date*

MonthDayYear
Date
Endorsements

Click Here for Additional License Fields
State
License Number
Class
Expiration Date

MonthDayYear
Date
Endorsements
State
License Number
Class
Expiration Date
Endorsements

DRIVING EXPERIENCE
Tractor & Semi Trailer
Type of Equipment*
Date From*

MonthDayYear
Date
Date To*

MonthDayYear
Date
Approximately # of Miles*

Click Here to Additional Experience Fields
Straight Truck
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approximately # of Miles
Tractor & 2 Trailers
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approximately # of Miles
Tractor & Tanker
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approximately # of Miles
Other
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approximately # of Miles

ACCIDENT RECORD FOR THE PAST 3 YEARS

Provide us with additional documents if more space is needed. Leave this page blank if none.
LIST MOST RECENT FIRST

Click Here for Additional Accident Fields
Accident Record
Accident Record

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (Other than parking violations)

Provide us with additional documentation if more space is needed. Leave this page blank if none.
TRAFFIC CONVICTIONS AND FORFEITURES

Click Here for Additional Conviction Fields
TRAFFIC CONVICTIONS AND FORFEITURES
TRAFFIC CONVICTIONS AND FORFEITURES
TRAFFIC CONVICTIONS AND FORFEITURES

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

YesNo
Has any of your license, permit, or privilege ever been suspended or revoked?*

YesNo

EDUCATION
Name of High School*
Location*
Course of Study
Years Completed*
Graduate*

YesNo

Click Here for Additional Education Fields
Name of College
Location
Course of Study
Years Completed
Graduate

YesNo

OTHER QUALIFICATIONS
Please list any other qualifications that you have and which you believe should be considered.

TO BE READ AND SIGNED BY APPLICANT
I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at any employment decision. I hereby release employers, schools, 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 also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.21. I understand that I have the right to:
- Review information provided by current/previous employers;
- Have errors in the information corrected by previous employers, and for those previous employers to resend 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
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.
Applicant Signature*

Clear
Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
Should be Empty: