DREAMLINER DRIVER APPLICATION

Dreamliner — FMCSA DOT Driver Employment Application

Dreamliner — 7471 Old Hickory Blvd., Whites Creek, TN 37207 | compliance@dreamlinercoaches.com
Full Name*
Social Security*
Date of Birth*

MonthDayYear
Date
Phone #*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you lived at this address the last 3 years?*

YESNO
If No, list all addresses for the past 3 years: *
Position Information
Position Applied For*
Date of Application*

MonthDayYear
Date
Date Available to Start*

MonthDayYear
Date
Rate of Pay Expected*
Type of Employment Expected*

Full TimePart TimeTemporary
Have you ever been employed by Dreamliner before?*

YESNO
If yes when?*
DRIVERS LICENSE INFORMATION
State Issued*
License #*
Class*
Expiration Date*

MonthDayYear
Date
Endorsements*
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

YESNO
If yes, please explain:*
Has any license, permit, or privilege ever been suspended or revoked?*

YESNO
If yes, please explain:*
DRIVING EXPERIENCE
Please List: Type of equipment: FROM (mm/yy) TO (mm/yy) : Approx miles (total) : Class of Equipment (truck, tractor-trailer, etc.)*
Accident Record (last 3 years) Nature of accident (head on, read end, etc.) Fatalities : Injuries: Hazardous Materials Spill
Any traffic convictions in the past 3 years? If so please explain. (Location/date/charge/penalty)*
References

Provide 3 professional references (not relatives):
1. Name*

First NameLast Name
1. Phone Number*
Please enter a valid phone number.
1. Relationship*
2. Name*

First NameLast Name
2. Phone Number*
Please enter a valid phone number.
2. Realtionship*
3. Name*

First NameLast Name
3. Phone Number*
Please enter a valid phone number.
3. Realtionship*
Certification and Release of Information

I certify that I have read and understand all of this employment application, and that all answers are true and complete to the best of my knowledge. I authorize Dreamliner to make investigations and inquiries of my personal, employment, financial, or medical history as may be necessary in arriving at an employment decision, including contacting previous employers. I understand that false or misleading information in my application may result in disqualification or dismissal.
Applicant Signature*

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Date*

MonthDayYear
Date
SECTION 2:

Authorization for Drug and Alcohol Testing
Applicant Name*
SSN*
I understand that as required by the Federal Motor Carrier Safety Regulations (49 CFR Part 40 and 382), all individuals applying for, or currently performing, safety-sensitive functions for Dreamline must submit to controlled substances and alcohol testing. I hereby voluntarily authorize Dreamliner Trucking Services and/ or its agents to conduct:*

Pre-employment controlled substance testingRandom, reasonable suspicion, post-accident, return-to-duty,and follow-up testing as required under DOT regulations
I understand that refusal to submit to testing, or a verified positive test result, will disqualify me from employment and/or continued operation of a commercial motor vehicle.
Applicant Signature*

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Date*

MonthDayYear
Date
Section 3 - Authorization to Release Prior Drug & Alcohol Testing Information

I hereby authorize my previous employers to release all records of my drug and alcohol testing history within the previous three (3) years from the date of this release, including:
- Verified positive drug test results
- Alcohol test results of 0.04 or greater
- Refusals to test
- Other violations of DOT drug and alcohol testing regulations
- Information on completion of return-to-duty processes, if applicable This information is to be released to: DREAMLINER TRANSPORTATION SERVICES
Applicant Signature*

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Date*

MonthDayYear
Date
Section 4 - Authorization for Background Investigation:

I authorize Dreamliner to make such investigations and inquiries of my personal, employment, financial, and medical history (as permitted by law) as may be necessary for employment decisions. I authorize all previous employers, schools, law enforcement agencies, and other persons to release information concerning my employment and driving history, character, and general reputation to Dreamliner Trucking Services and its agents. I hereby release all persons and organizations furnishing such information from any and all liability or damage in connection with the furnishing or use of this information.
Applicant Name*
Social Security*
Date of Birth*

MonthDayYear
Date
Driver License*
State*
Applicant Signature*

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Date*

MonthDayYear
Date
Section 5 - Authorization for Motor Vehicle Record (MVR)
Request

In accordance with 49 CFR391.23 and applicable state motor vehicle privacy laws, I authorize Dreamliner to obtain my Motor Vehicle Record (MVR) from any state in which I have held a driver's license during the past three (3) years. I understand this report will be used for employment purposes and ongoing safety compliance.
Driver Name*
License #*
State*
Date of Birth*

MonthDayYear
Date
Signature*

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Date*

MonthDayYear
Date
Section 6 - FMCSA Clearinghouse Consent

In accordance with 49 CFR Part 382 Subpart G, I authorize Dreamliner Trucking Services to conduct a pre-employment Clearinghouse query and limited annual queries to determine whether drug or alcohol violations exist in the FMCSA database under my name.

I understand I will be required to log into the FMCSA Clearinghouse to provide electronic consent for the full query before employment can be finalized.
Driver Name*
Driver License*
State*
Date of Birth*

MonthDayYear
Date
Signature*

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Date*

MonthDayYear
Date
Section 7: Certification & Signature

I certify that I have completed this application truthfully and completely. I understand that any false or misleading information may result in disqualification from employment or termination if discovered after hire.
Applicant Signature*

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Date*

MonthDayYear
Date
Document Uploads
Drivers License (Front&Back)*

Cancelof
DOT MEDICAL CARD*

Cancelof
MVR/DRIVING RECORD*

Cancelof
Signature*

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Date*

MonthDayYear
Date
By submitting you authorize Dreamliner to obtain required records.
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Dreamliner — FMCSA DOT Driver Employment Application

Position Information

DRIVERS LICENSE INFORMATION

DRIVING EXPERIENCE

References

Document Uploads

By submitting you authorize Dreamliner to obtain required records.