• Driver Employement Application

    COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED
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  • Date of Birth *
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  • Heading

  • Date of Application *
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  • Date of Hire *
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  • PREVIOUS THREE YEARS RESIDENCY

  • 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. Include all licenses held for the past 3 years; attach additional sheets if needed.
  • License Expiration Date *
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  • DRIVING EXPERIENCE


  • Start Date*
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  • To Date*
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  • Start Date
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  • To Date
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  • Start Date
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  • To Date
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  • ACCIDENT RECORD FOR THE PAST 3 YEARS

  • First Accident - Date (Leave blank if No Violation)
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  • Second Accident - Date (Leave blank if No Violation)
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  • TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

  • First Violation - Date (Leave blank if No Violation)
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  • Second Violation - Date (Leave blank if No Violation)
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  • Third Violation - Date (Leave blank if No Violation)
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  • Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
  • Has any license, permit, or privilege ever been suspended or revoked?*

  • EMPLOYMENT HISTORY

    We 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 a 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.
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  • Date on which work started at most recent Employer
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  • Last date of work at most recent Employer
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  • While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Hint : Hint: Press yes if you were driving Commercial Motor vehicle to United States with this employer or NO if you do not have Second Last employer*
  • Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required? Hint : You will press yes if you have ever given a Drug and Alcohol test for this job or press NO if not done.*

  • Second Most Recenet Employer Details

  • Date on which work started at Second most recent Employer
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  • Last date of work at Second most recent Employer
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  • While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Hint : Hint: Press yes if you were driving Commercial Motor vehicle to United States with this employer or NO if you do not have Second Last employer*
  • Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required? Hint : You will press yes if you have ever given a Drug and Alcohol test for this job or press NO if not done.*

  • Third Most Recenet Employer Details

  • Date on which work started at Third most recent Employer
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  • Last date of work at Third most recent Employer
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  • Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required? Hint : You will press yes if you have ever given a Drug and Alcohol test for this job or press NO if not done.*
  • While employed here, were you subject to the Federal Motor Carrier Safety Regulations? Hint : Hint: Press yes if you were driving Commercial Motor vehicle to United States with this employer or NO if you do not have Second Last employer*

  • Education

  • High School Details

  • Did You Graduated?( Mark NOT APPLICABLE if you have nothing to enter here)*

  • College Details

  • Did You Graduated at college ?( Mark NOT APPLICABLE if you have nothing to enter here)*

  • 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 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.
  • Date *
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  • Cell Phone Usage Policy

    At all times, the worker’s first responsibility is to their own personal safety and the safety of other drivers, pedestrians and the passengers in their vehicle.▪ Dispatch is received by cell phone▪ Workers must adhere to all provincial, state or local rules and regulations regarding the use of cell phones/hand held devices while driving. Accordingly, workers must not use such devices if such conduct is prohibited by law, regulation or other ordinance.
  • Mark Date of Application
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  • Driver Disclosure of Convictions and At-FaultTrafficAccidents

    I hereby declare that the following is a true and complete list of convictions and accidents required to be reported under the Highway Traffic Act, Sec 318.1(3).
  • First Violation Date
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  • Second Violation Details

  • Second Violation Date
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  • I hereby certify that I have not had any convictions (other than parking and mobile or intersection photo enforcement convictions) or accidents required to be reported under the Highway Traffic Act, Sec 318.1(3) that have occurred while operating any motor vehicle in the previous 12 months.

  • Mark Date of Application
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  • Driver Disclosure of Licence

    DeclarationPursuant to Section 318.1(3) of The Highway Traffic Act, I hereby declare that:• I am not licensed to drive in any jurisdiction other than the one named below.• I do not hold any driver’s licence in any other names.• My driver’s licence is valid and is not suspended.• I will immediately inform the motor carrier in writing of any convictions or accidents that occur while I am operating any motor vehicle.• I will immediately inform the motor carrier of any suspensions, restrictions, prohibitions, or cancellation of my driver’s licence
  • Date of Birth*
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  • Employment Application Date*
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  • General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

  • I(Your Name),   *   *   hereby provide consent to (Company Name) * 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.
    Is the driver consenting to a single limited query and/or multiple limited queries? Check mark the appropriate
    1) Single   *     
    2) Multiple______
    Is the number of limited queries specific or unlimited? Check mark the appropriate
    1) Specific ______
    2) Unlimited __   *      ____
    I understand that if the limited query conducted by the above-mentioned company indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the above mentioned company without first obtaining additional specific consent from me.
    I further understand that if I refuse to provide consent for the above-mentioned company to conduct a limited query of the Clearinghouse, the above mentioned company must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

  • Date*
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  • PRE-EMPLOYMENT DRUG AND ALCOHOL QUESTIONNAIRE

  • Within the last three (3) years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?*
  • If yes, have you successfully completed the return-to-duty process?

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