Driver Application for Employment

Driver Prequalification

Please answer the following questions to confirm eligibility.
Are You At Least 25 Years of Age?*

YesNo
Do you have a valid Passenger Endorsement on your CDL?*

YesNo
Do you have a valid Air Brake Endorsement on your CDL?*

YesNo
Do you have a combined total of 24 Months or more CDL driving experience?*

YesNo
We are sorry, but based on your answers you do not meet the federal requirements for employment with our company.
You may close the browser without proceeding.

DRIVER APPLICATION FOR EMPLOYMENT
ADVENTURE ENTERPRISES, LLC
6410 Highway 30, East Ste. C; PO Box 1570
Kearney, Nebraska 68848
Applicant Name*
Date of Application*

MonthDayYear
Date
In compliance with Federal and State equal employment opportunity laws, qualified applicant are considered for all position without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

I understand that information I provide regarding current and/or previous 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(d) and (e I understand that I have the right to:
- Review information provided by previous employers;
- Have errors in the information corrected by previous employers and for those previous employers to re-send 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.
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Signature

Clear
Date*

MonthDayYear
Date

APPLICANT TO COMPLETE
Position Applying For:*
Position(s) Applied for*
Name*
Last, First, Middle
Social Security No.*
Current Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Please enter a valid phone number.
How long have you resided at your current residence?
Year/Month

How long have you lived at your current residence?

In years and months:
Years*
Months*
Previous Address #1

Street Address

Street Address Line 2

CityState

Zip Code
How long did you live at this residence?

In years and months:
Years
Months
How long did you reside at this residence?
Year/Month
Previous Address #2

Street Address

Street Address Line 2

CityState

Zip Code
How long did you live at this residence?

In years and months:
Years
Months
How long did you reside at this residence?
Year/Month
Previous Address #3

Street Address

Street Address Line 2

CityState

Zip Code
How long did you live at this residence?

In years and months:
Years
Months
How long did you reside at this residence?
Year/Month

List states operated in for last five years*
Do you hold any Special Licenses or Training that will help you as a driver?

YesNo
Please describe them here:
Do you hold any safe driving awards?

YesNo
Which safe driving awards do you hold and from whom?

Education
Highest Grade Completed*
Name of Last School Attended*
City*
State*
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Signature

Clear
Date*

MonthDayYear
Date

Motor Carrier's MEDICAL EXAMINER'S NATIONAL REGISTRY VERIFICATION
MOTOR CARRIER INSTRUCTIONS: The requirement to include verification of the medical examiner's National Registry listing in the driver's qualification file was published in the Federal Registry April 20, 2012. Beginning May 21, 2014, motor carriers must verify that the medical examiner who signed the driver's medical card is listed on the National Registry. This requirement is prescribed in $391.23 and $391.51.

$391.23 Investigation and inquiries. (m1) The motor carrier must obtain an original or copy of the medical examiner's certificate issued in accordance with $391.43, and any medical variance on which the certification is based, and, beginning on or after May 21, 2014, verify the driver was certified by a medical examiner listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner's certificate, and place the records in the driver qualification file, before allowing the driver to operate a CMV. (§391.23(m1

$391.51 General requirements for driver qualification files. (b9) A note relating to verification of medical examiner listing on the National Registry of Certified Medical Examiners required by $391.23(m (§391.51(b9

MOTOR CARRIER VERFICATION: The following medical examiner has been verified as being listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner's certificate for
Driver's Name*
Medical Examiner Identification Number*
Found on the left side of your DOT Physical Card
Medical Examiner Name*
Found on your DOT Physical card
Examiner National Registry Number*
Found on lower right side of your DOT Physical card

Disclosure Regarding Background Investigation
Employer Adventure Enterprises LLC may obtain information about you from Public Record for employment purposes. Thus, you may be the (insert source of report)

subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living and which can involve personal interview with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history verification. These searches will be conducted by: Adventure Enterprises LLC 6410 Highway 30 East Ste. C; PO Box 1570 Kearney Nebraska 68847.

The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organizations all manner of consumer reports throughout the course of your employment to the extent permitted by law.
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Signature

Clear
Date*

MonthDayYear
Date

Request for Check of Driving Record
I do hereby authorize the Division of Motor Vehicles to release my driving record to: Adventure Enterprises LLC and/or a third party consumer reporting agency, and any of their authorized agents for use by my prospective/current employer.

This authorization shall remain on file and in effect at any time during my employment period or until I file a formal withdrawal.

I understand I have the right to ask Adventure Enterprises LLC, if a consumer report has been run about me.
Driver's Full Name*
(As it appears on the driver's license)
Driver's Current Address*
Driver's Former Address*
DOB (Date of Birth)
* / * / *
Date of Birth

MonthDayYear
Driver's License Number*
Signature

Clear
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Date*

MonthDayYear
Note to Residents of California, Massachusetts, Minnesota, New Jersey, and Oklahoma: As part of authorizing your use of a fleet vehicle, your consumer report may be obtained and reviewed. By state law, you may receive a free copy of your report from your employer by checking the box below.

Yes, I am a resident of California, Massachusetts, Minnesota, New Jersey or Oklahoma and would like a free copy of
Note to Residents of Alaska, British Columbia, Manitoba, Newfoundland & Labrador, New Hampshire, Northwest Territories, Pennsylvania, Puerto Rico, Quebec, Saskatchewan, and Washington: State specific motor vehicle release forms must be completed and signed prior to obtaining the reports.

Motor Vehicle Driver's CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS
MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing or rated at 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing or rated at 10,001 pounds or more, can transport more than 15 people (or more than 8 people when there is direct compensation), or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain certain driver licensing requirements that you as a driver must comply with, including the following:

1) POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator's license

2) NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.15(b2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation, suspension, cancellation, or disqualification of your driver's license or driving privilege. In addition, Section 383.31 requires that any time you are convicted of violating a state or local traffic law (other than parking), you must report it within 30 days to your employing motor carrier. The notification must be in writing.

3) CDL DOMICLE REQUIREMENT: Section 383.23(a2 requires that your commercial driver's license be issued by your legal state of domicile, where you have your true, fixed, and permanent home and principal residence and to which you have the intention of returning whenever you are absent. If you establish a new domicile in another state, you must apply to transfer your CDL within 30 days.

The following license is the only one I possess:
Driver's License No.*
State
State*
Exp. Date*

MonthDayYear
Date
DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.
Driver's Name (Printed)*
Driver's Signature

Clear
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Date*

MonthDayYear
Date
Note

MOTOR VEHICLE DRIVER'S Certificate of Violations/Annual Review of Driving Record
MOTOR CARRIER INSTRUCTIONS: Each motor carrier shall at least once every 12 months, require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted, or on account of which he/she has forfeited bond or collateral during the preceding 12 months (Section 391.27 Drivers who have provided information required by Section 383.31 need not repeat that information on this form.

DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section 391.27
COMPLETED BY DRIVER - CERTIFICATION OF VIOLATIONS
I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.
Driver's Signature

Clear
General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse for the Duration of Employment

I, the "Driver" whose name appears below, hereby provide consent to ADVENTURE ENTERPRISES LLC to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether a drug or alcohol violation information about me exists in the Clearinghouse. Driver consents to unlimited multiple limited queries, for the duration of employment.

I understand that if the limited query conducted by ADVENTURE ENTERPRISES LLC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to ADVENTURE ENTERPRISES LLC without first obtaining additional specific consent from me.

of I further understand that if I refuse to provide consent by ADVENTURE ENTERPRISES LLC to conduct a limited query

the Clearinghouse, ADVENTURE ENTERPRISES LLC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
Read, Acknowledged and Consented to this * day of * , 20 .
Driver Signature (By typing your name here, you agree that your e-signature shall have the same legal standing as your written signature.)*
Name*

First NameLast Name
CDL #*
State of Issue*
Country of Issue*
State of Issue*
Two-letter code (i.e., NE)
Country of Issue*
DOB (Date of Birth)
* / * / *
Personal Email*
example@example.com
Phone Number*
These Documents are required for us to proceed with the Application process. Please make sure that they are completely clear and legible.
DOT Physical/Medical Card*

Cancelof
CDL (Front)*

Cancelof
CDL (Back)*

Cancelof
Social Security Card (Front)*

Cancelof
Social Security Card (Back)*

Cancelof
Should be Empty:

	Dates	Nature of Accident (Head-On, Rear-End, Upset, Etc.)	Fatalities	Injuries	Hazardous Material Spill
Last Accident
Next Previous
Next Previous

	Experience	Type of Equipment	From (M/Y)	To (M/Y)	Approx. No. of Miles (Total)
Straight Truck
Tractor and Semi-Trailer
Tractor – Two Trailers
Tractor – Three Trailers
Motorcoach – School Bus (>8 passengers)
Motorcoach – School Bus (>15 passengers)
Other

	Charge	Date	Location
#1
#2
#3

	State	License No.	Class	Endorsements	Expiration Date
#1
#2
#3
#4

Driver Prequalification

DRIVER APPLICATION FOR EMPLOYMENT

APPLICANT TO COMPLETE

How long have you lived at your current residence?

How long did you live at this residence?

How long did you live at this residence?

How long did you live at this residence?

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE

Education

TO BE READ AND SIGNED BY APPLICANT

Motor Carrier's MEDICAL EXAMINER'S NATIONAL REGISTRY VERIFICATION

Disclosure Regarding Background Investigation

Request for Check of Driving Record

Motor Vehicle Driver's CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

MOTOR VEHICLE DRIVER'S Certificate of Violations/Annual Review of Driving Record

COMPLETED BY DRIVER - CERTIFICATION OF VIOLATIONS