Class A Hazmat Fuel Driver – Job Application

Class A Hazmat Fuel Driver – Job Application | Energy Line LLC

Apply for the Class A Hazmat Fuel Driver position by providing your personal information, qualifications, and experience.
Personal Information

Please provide your contact and identification details.
Full Name (First, Middle, Last)*

First NameMiddle Name or InitialLast NameSuffix
Drivers License Number*

DLNConfirm DLN
Social Security Number*

SSNConfirm SSN
Drivers License Expiration Date*

MonthDayYear
Date
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Primary Phone*
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Street Address, APT No.*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Years at Current Address*
Driver Information

Your driver type, terminal, and recruiter information.
Date Available to Start*

MonthDayYear
Date
How did you hear about us?*
License & Certifications

Your CDL, endorsements, and medical card information.
Do you currently hold a Class-A CDL?*

YesNo
State of License*
License Expiration Date*

MonthDayYear
Date
Endorsements (check all that apply)*

Hazmat (TSA Cleared)Tanker
Do you have a DOT Medical Card?*

YesNo
DOT Card Expiration Date

MonthDayYear
Date
Do you have a TWIC card?*

YesNo
Safety & Compliance

Please answer the following safety and compliance questions.
Any accidents or incidents in the past 3 years?*

YesNo
Any moving violations in the past 4 years?*

YesNo
Any DUI/DWI or drug/alcohol convictions in the past 10 years?*

YesNo
Any cell phone violations in the past 3 years?*

YesNo
Has your license ever been suspended or revoked?*

YesNo
Have you failed or refused a DOT drug or alcohol test in the past 3 years?*

YesNo
Driving Experience

Your verifiable driving experience and skills.
Years of verifiable CMV driving experience*
Experience with manual transmission?*

YesNo
Fuel hauling experience?*

YesNo
Other truck or trailer experience?*

YesNo
Months of other truck/trailer experience
Experience driving in adverse weather?*

YesNo
Experience driving in heavy traffic / major cities?*

YesNo
Work History (up to 5 employers)

Provide details for up to 5 previous employers.
Work History*
Military & Work Authorization

Military service and legal work eligibility.
Have you served in the military?*

YesNo
Are you legally authorized to work in the U.S.?*

YesNo
Physical & Job Requirements

Ability to perform essential job functions.
Can you perform essential driver duties?*

YesNo
Can you sit for long periods?*

YesNo
Can you stand and walk up to 8 hours per day?*

YesNo
Can you lift up to 50 lbs repeatedly?*

YesNo
Can you work nights, weekends, and holidays?*

YesNo
Can you work maximum DOT hours?*

YesNo
Any issues with slip-seating?*

YesNo
Comfortable driving nights and sleeping during the day?*

YesNo
Affirmative Action (Optional)

Completion of this section is voluntary and will not affect your application.
Gender
Race/Ethnicity
Veteran Status
Disability Status
Applicant Certification

Please read and sign below to certify your application.
Applicant Signature*

Clear
Background Check Disclosure By signing, I authorize Energy Line LLC to obtain a background check through Checkr or another background check service. I understand that this report may contain information related to my criminal history, credit report, and other relevant information for employment purposes. I acknowledge that I have received a copy of this notice before signing, and I am aware of my rights under the Fair Credit Reporting Act (FCRA). I also understand that I can print a copy of this disclosure for my records while completing the application.
Date*

MonthDayYear
Date
Should be Empty:

Class A Hazmat Fuel Driver – Job Application | Energy Line LLC

Personal Information

Driver Information

License & Certifications

Safety & Compliance

Driving Experience

Work History (up to 5 employers)

Military & Work Authorization

Physical & Job Requirements

Affirmative Action (Optional)

Applicant Certification