Express Couriers Application

  • Driver Employment Application

  • Date of Birth:
     - -
  • Date of Application:
     - -
  • Date Available to Work:
     - -
  • Format: (000) 000-0000.
  • Position:
  • Do you have the legal right to work in the US?

  • Previous two years of residency

    Current

  • Drivers License Information

    No person who operates a commercial motor vehicle shall at any time have more than on 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;
  • License Expiration Date:
     - -

  • Driver Experience

  • Type of Equipment ( Van, Tank, Flat, Sprinter, Etc.)
  • Check to Confirm:

  • Vehicle Information

    For all independent contractors
  • What type of vehicle do you own?

  • Accident Record For The Past 3 Years

  • Have you had any accidents within the last 3 years?
  • Have you had any Traffic Convictions and Forfeitures for the Past 3 years (Other than parking violations)?

  • Required Questions

  • Have you ever been denied a license, permit or privilege to operate a motor vehicle?
  • Has a license, permit or privilege ever been suspended or revoked?
  • Have you ever been convicted of any criminal act involving the use of CMV or while driving a CMV?
  • Have you ever been convicted of any law violation? ( Include ANY pleas of "Guitly" or "No Contest" except for minor traffic violation?

  • Education

  • Graduate:
  • Graduate:
  • Graduate:

  • Employment History

    391.21(b)(10) A list of the names and addresses of the applicant's employers during the 3 years proceeding the date the application is submitted, together with the date's he/she was employed by, and his/her reason for leaving the employ of, each employer. (b)(11) For those drivers applying to operate a commercial motor vehicle as defined by Part 383 of the subchapter, a list of the names and addresses of the applicant's employers during the 7 year period preceding the 3 years contained in paragraph (b)(10) of this section for which the applicant was an operator of a commercial motor vehicle, together with the dates of employment and the reasons for leaving such employment.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Current or Most Recent Employer

  • Employment Start Date:
     - -
  • Employment End Date:
     - -
  • Format: (000) 000-0000.
  • May we contact?
  • Were you ever employed in a safety sensitive function subject to DOT Drug & Alcohol Testing?
  • Were you subject to Federal Motor carrier Safety Regulations?

  • Next Previous Employer

  • Employment Start Date:
     - -
  • Employment End Date:
     - -
  • Format: (000) 000-0000.
  • May we contact
  • Were you ever employed in a safety sensitive function subject to DOT Drug & Alcohol testing?
  • Were you subject to Federal Moto Carrier Safety Regulations?

  • Next Previous Employer

  • Employment Start Date:
     - -
  • Employment End Date:
     - -
  • Format: (000) 000-0000.
  • May we contact?
  • Were you ever employed in a safety sensitive function subject to DOT Drug & Alcohol testing?
  • Were you subject to Federal Motor Carrier Safety Regulations?

  • 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 ALLEDGED 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 FEDRAL MOTOR CARRIER SAFETY REGULATIONS.
  • Should be Empty: