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

  • Format: (000) 000-0000.
  • Date of Birth*
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  • Date of Application*
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  • Date Available To Work*
     - -

  • PREVIOUS THREE YEARS RESIDENCY

    Provide us with additional document if more space is needed.
    • Click Here for Additional Address Fields 

  • 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.
  • Expiration Date*
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    • Click Here for Additional License Fields 
    • Expiration Date
       - -

  • DRIVING EXPERIENCE

  • Tractor & Semi Trailer

  • Date From*
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  • Date To*
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    • Click Here to Additional Experience Fields 

    • Straight Truck

    • Date From
       - -
    • Date To
       - -

    • Tractor & 2 Trailers

    • Date From
       - -
    • Date To
       - -

    • Tractor & Tanker

    • Date From
       - -
    • Date To
       - -

    • Other

    • Date From
       - -
    • Date To
       - -

  • ACCIDENT RECORD FOR THE PAST 3 YEARS

    Provide us with additional documents if more space is needed. Leave this page blank if none.
    • Click Here for Additional Accident Fields 

  • 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.
    • Click Here for Additional Conviction Fields 
  • Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
  • Has any of your license, permit, or privilege ever been suspended or revoked?*

  • EMPLOYMENT HISTORY

    The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

  • Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

  • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?*
  • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?*
    • Click Here for Additional Employer Fields 
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

  • EDUCATION

  • Graduate*
    • Click Here for Additional Education Fields 
    • Graduate

  • OTHER QUALIFICATIONS

  • 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.

  • Date*
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  • Should be Empty: