CDL Driver Application

To the applicant: D Wade Logistics does not discriminate in hiring or employing on the basis of race, color, religion, sex, national origin, age, disability, or any other legally protected status. No question on the application is intended to secure information to be used for such discrimination. Consideration of this application will be given. However, by receiving this document, D Wade Logistics. Is under no obligation of employment to the applicant.
Date*
Position Applying For*
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
SS# (Required for Drug Test)*
DOB*
Email*
example@example.com
Are you 18 years of age of older?*

YESNO
Do you have the legal right to live and work in the U.S.?*

YESNO
If hired, can you provide the documentation required by U.S. Law?*

YESNO
Have you ever been convicted of a misdemeanor or felony? (A conviction will not necessary disqualify you from employment. Each conviction will be judged on its own merits with respect to time, circumstance and seriousness.)*

YESNO
Have you ever been employed with D Wade Logistics?*

YESNO
If so, when?

MonthDayYear
Date
The following information is required by the U.S. Department of Transportation, Section 391.21. Your application will not be considered if all information is not furnished.
PREVIOUS 3 YEARS RESIDENCY
Current Address*
# of Years at Address*
Previous Address
# of Years at Address
Previous Address
# of Years at Address
Driver's License/CDL #*
Expiration Date*

MonthDayYear
Date
Medical Card/DOT Physical Expiration Date*

MonthDayYear
Date
Previous Licenses Held*
If none, type N/A
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

YESNO
If so, please explain.
Has one ever been suspended?*

YESNO
If so, please explain.
Have you ever been disqualified for violations regarding Safety Regulations?*

YESNO
If so, please explain.
Are you currently employed?*

YESNO
If so, may we contact your current employer?*

YESNO
If you were accepted for employment, when would you be available?*

MonthDayYear
Date
Previous Employers

Starting with your most current for the past seven (7) years.
Employer Name*
Position Help*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
City/State*
Phone Number*
Please enter a valid phone number.
Equipment Operated*
Materials Hauled*
Reason for Leaving*
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR's) requirements?*

YESNO
Employer Name
Position Held
From

MonthDayYear
Date
To

MonthDayYear
Date
City/State
Phone Number
Please enter a valid phone number.
Equipment Operated
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?

YESNO
Employer Name
Position Held
From

MonthDayYear
Date
To

MonthDayYear
Date
City/State
Phone Number
Please enter a valid phone number.
Equipment Operated
Materials Hauled
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?

YESNO
Explain any gaps in employment (include month/year)*
Please list any qualifications you believe should be considered. (Endorsements, etc)*
Accident Record
List the Date, Nature of the Accident, Fatalities & Injuries*
Traffic Convictions
Please list the date, type of violations, state of violation & penalty for the last three (3) years.*
Background Check For Employment Purposes
D Wade Logistics may request a comprehensive review of your background information from a consumer reporting agency in connection with your employment application and for employment purposes, including promotion,reassignment, or retention as an employee. Your background information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at any time after receipt of your authorization andthroughout the course of your employment. Order Screening Solutions, PO Box 25406, Overland Park, KS 66225-5406, (866)915-0792, www.validityscreening.com, and its designated agents and representatives or another consumer reporting agency will prepare or assemble the reports. The scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: consumer credit; names and dates of previous/current employment; worker’s compensation claims;criminal history records (from federal, state, local, international, and other law enforcement agencies’ records); sexual offender’s lists; wants and warrants records; motor vehicle records; military records; educational verification; license verification; civil cases; OIG/GSA; OFAC/patriot act; any sanction lists; fingerprinting; and drug testing. These reports may include information as to your general reputation, character, personal characteristics, mode of living, work habits, job performance, and experience along with reasons for termination of past employment from previous employers. You may request more information about the nature and scope of any investigative consumer report by contacting the Company you are applying to. A Summary of Your Rights Under the Fair Credit Reporting Act is also being provided to you.
I blanks authorize the complete release of records or data pertaining to me which an individual, company, firm, corporation, institution, school or university, law enforcement or public agency may have to Order Screening Solutions, PO Box 25406, Overland Park, KS 66225-5406, (866) 915-0792, www.validityscreening.com. I authorize the full release of the information described above, without any reservation, and throughout the duration of my employment at the Company. This authorization and consent shall be valid in original, facsimile (“fax”), or copy form.
Signature*

Clear
Employment & Safety Performance & Verification w/ Previous Employers
I blanks authorize D Wade Logistics 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 an 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 391.23. 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.
Signature*

Clear
General Consent for Limited Queries of the (FMCSA) Drug and Alcohol Clearinghouse (§382.703)
I, blanks hereby provide consent to D Wade Logistics or a consortia/third-party administrator (C/TPA) or other service agent designated by D Wade Logistics to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. Limited queries of the Clearinghouse will be conducted to satisfy compliance with 49 CFR §391 and may also be conducted to satisfy additional company safety requirements for the duration of employment. I understand that if the limited query conducted by D Wade Logistics indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to D Wade Logistics without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for D Wade Logistics to conduct a limited query of the Clearinghouse, D Wade Logistics must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
Signature*

Clear
Drug and Alcohol Screening Consent (REG 382.301)
I, blanks understand and consent to performing a drug screening prior to being employed with D Wade Logistics. I understand my drug screening cannot confirm anything other than negative in order to be employed with D Wade Logistics.
Signature*

Clear
Application Signature
Upon signing the application, I agree and confirm that all information given on this appliation is correct and truthful information. I agree that I the applicant completed this application without assistance from any parties. I understand that if any information is found to be untruthful, my employment can be terminated at anytime without notice.
Signature*

Clear
Valid Driver's License
Valid Medical Card
Date*

MonthDayYear
Date
Should be Empty:

PREVIOUS 3 YEARS RESIDENCY

Previous Employers

Accident Record

Traffic Convictions

Background Check For Employment Purposes

Employment & Safety Performance & Verification w/ Previous Employers

General Consent for Limited Queries of the (FMCSA) Drug and Alcohol Clearinghouse (§382.703)

Drug and Alcohol Screening Consent (REG 382.301)

Application Signature