CDL A Driver Application

CDL A Driver Application
Thank you for your interest in Aquidneck Trucking, LLC. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions 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 fill out this form, you will need to know the following:
- Social Security Number
- Home address history for the past 3 years
- Current driver license number and driver license history for the past 3 years
- Employment history
- History of traffic accidents, violations and/or convictions from the last 3 years (including DUI or reckless driving conviction and license suspension)
- Military history (if applicable)
Required entry fields are followed by *, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at 978-252-0133.
Name*

First NameLast Name
Cell Phone Number*
Email*
Date of Birth*

MonthDayYear
Date
SSN / SIN*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you resided at this address for more than 3 years?*

YesNo
Are you legally authorized to work in the United States?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If Yes, explain:
Have you served in the military?

YesNo

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

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

YesNo
Have you had any accidents, traffic convictions, and/or forfeitures within the past 3 years? (Not including parking violations)*

YesNo
If you answered 'Yes' to any of the above questions please explain here:
License Number*
Expiration Date*

MonthDayYear
Date
State*
Type/Class*
Driving Experience / Endorsements / Previously Held Licenses*

Employment History
Are you Currently Employed*

YesNo
If you answered 'No' above, how long has it been since your last employment?
Current (most recent) Employer*
Phone Number*
Please enter a valid phone number.
Employed From (Month/Year)*

MonthDayYear
Date
Employed To (Month/Year) *

MonthDayYear
Date
Reason for Leaving
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?*

YesNo
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?*

YesNo
Second (most recent) Employer
Phone Number
Please enter a valid phone number.
Employed From (Month/Year)

MonthDayYear
Date
Employed To (Month/Year)

MonthDayYear
Date
Third (most recent) Employer
Phone Number
Please enter a valid phone number.
Employed From (Month/Year)

MonthDayYear
Date
Employed To (Month/Year)

MonthDayYear
Date

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
Today's Date*

MonthDayYear
Date
Signature*

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CDL A Driver Application

License and Driving Experience

Employment History