PTI DRIVER FORM

Pristine Transport Inc. | Driver Qualification & Application

(Prepared in accordance with 49 CFR §391.21)
Are you applying as a Company Driver or an Owner-Operator?*

Company Driver (Driving company equipment)Owner-Operator / Lease-on
Equipment Details*

Qualification Check

The next few questions will help determine if you meet our current safety and insurance requirements. This should take less than 2 minutes. If you qualify, you will move directly to the full DOT application. If not, we won't waste your time with the long paperwork.

Are you at least 21 years of age? (Required for interstate commerce).*

Yes, I am 21 or older.No, I am under 21.

Do you currently have a valid CDL?*

YesNo

How many years of Class A CDL experience do you have?*

Less than 1 year1–2 years2–5 years5+ years

Do you have a current and valid DOT Medical Card?*

Yes, my medical card is valid.No, my medical card is expired or I don't have one.

How many minor moving violations have you had in the last 3 years? Example: Speeding (less than 15 mph over the limit), Failure to obey a traffic sign/signal, Improper Lane change, Following too closely, Seatbelt violations etc.*

0 (None)1 violation2 violations3 or more violations

Have you had any major violations in the last 3 years? (DUI, Reckless Driving, Leaving the Scene, or Suspended License).*

None1 violation2 violations3 or more violations

Have you been involved in a DOT-recordable accident (Fatality, Injury, or Tow-away) in the last 3 years?*

NoYes

Were you cited or found "At-Fault" for this accident?*

No, I was not at faultYes, I was at fault.

What was the outcome of the commercial vehicle accident?*

Injury: Someone required immediate medical treatment away from the scene.Fatality: Someone passed away as a result of the accident.Tow-Away: One or more vehicles had to be towed from the scene due to disabling damage.None of the above: (Fender bender/minor incident).

BOOM! Congratulations! Based on your initial safety and experience responses, You passed the pre-qual.

You’re cleaner than a polished chrome bumper on a sunny Sunday. Since you're already parked and the logbook is behaving, do you want to knock out the full application now? It’s a bit of a marathon (10-year history and the legal stuff), but we promise it’s less painful than a 4-hour wait at a receiver.
Note: If you need to stop and finish later, Click Save and link will be emailed to you.
Send it! Let's get this paperwork over with.

Status: Minimum Age Requirement Not Met

"Thank you for your interest in Pristine Transport Inc. To comply with Federal Motor Carrier Safety Regulations regarding interstate commerce, all our drivers must be at least 21 years of age. Because you are currently under 21, we cannot proceed with your application. We encourage you to reach back out to us once you reach this milestone."

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Status: License Requirement Not Met

"Thank you for applying. At this time, Pristine Transport Inc. is only hiring drivers who hold a valid Class A Commercial Driver’s License (CDL). As you indicated you do not have a Class A license, we are unable to move forward. We wish you the best in your career and safety on the road."

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Status: Medical Certification Required

"To operate commercially for Pristine Transport Inc., a current and valid DOT Medical Examiner’s Certificate is required by law. Since you indicated you do not have a valid medical card, we cannot proceed. Please feel free to re-apply once you have successfully passed your DOT physical and updated your certificate."

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Safety Compliance Requirement

"Thank you for your interest. To maintain our insurance standards, Pristine Transport Inc. requires drivers to have no more than two (2) minor moving violations within a 3-year period. Because your record shows three or more, we are unable to move forward at this time. We wish you continued success and safety."

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Status: Major Violation Disqualification

"After reviewing your safety responses, we have determined that we cannot proceed with your application. Our company policy requires a driving record free of major violations (such as DUI, Reckless Driving, or Suspended License) within the last 3 years. We appreciate your time and interest in our fleet.

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Status: Accident History Requirement Message:

"Thank you for applying to Pristine Transport Inc. To protect our safety ratings, we require a 3-year history free of at-fault DOT-recordable accidents (incidents involving a fatality, injury, or tow-away). Because you indicated an at-fault accident of this nature, we cannot move forward with your file at this time."

Questions or Concerns?

Phone: 559-527-5276
Email: admin@pristinetrans.com

Status: Minimum Experience Not Met

Thank you for your interest in Pristine Transport Inc. We appreciate the time you took to share your background with us.

To maintain our current safety standards and meet the specific requirements of our insurance carrier, we require all drivers to have a minimum of one (1) year of verifiable Class A CDL experience. Because you indicated that you currently have less than one year of professional driving experience, we are unable to proceed with your application at this time.

We highly value new drivers entering the industry and encourage you to re-apply once you have reached your one-year milestone. Safe travels as you continue your career.

If you have any questions or feel there has been a mistake, please contact us:

Phone: 559-527-5276
Email: admin@pristinetrans.com

I. Applicant Personal Data
Full Legal Name*

First NameMiddle NameLast Name
Social Security Number (Required for Background & Clearinghouse check)*
Date of Birth*

MonthDayYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Current Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long have you lived at this address?*

3+ yearsLess then 3 Year

Previous Addresses (Last 3 Years) (List all addresses for the past 36 months).*

Rows	Street Address	City	State	Zip Code	Date: Example (01/01/205-01/02/2026)
Address 1
Address 2
Address 3

II. License & Experience
CDL Information:*
Driving Experience: *
List types of equipment (e.g., Van, Reefer, Flatbed) and approximate mileage/years:
Has your license, permit, or privilege to operate a motor vehicle ever been denied, suspended, or revoked? (If yes, explain).*

YesNo
Explain:*
Please upload CDL copy*

Cancelof
Medical Examiner’s Certificate Expiration Date*

MonthDayYear
Date
Upload Medical Certificate*

Cancelof

III. Employment History (Strict Requirements)

In accordance with 49 CFR 391.21, list all employers for the last 3 years. CDL drivers must also list any employer for whom they operated a CMV in the last 10 years.
DOT requires 10 years of history for CDL drivers. Please start with your most recent employer.

Per FMCSR §391.21:

3-Year History: All drivers must list every employer for the past 3 years.

10-Year History: CDL Drivers must also list any employer for whom they operated a CMV in the last 10 years.
Employment History (Strict Requirements)*
(Repeat as necessary to fulfill the 3/10 year requirement)

IV. Accident & Violation History (Past 3 Years)
List all accidents (Date, Nature, Injuries/Fatalities):*
List all motor vehicle violations (other than parking) for which you were convicted: Example: Speeding (less than 15 mph over the limit), Failure to obey a traffic sign/signal, Improper Lane change, Following too closely, Seatbelt violations etc.*

V. SUPPLEMENTAL DRUG AND ALCOHOL DISCLOSURE

(Required by 49 CFR §391.23(e) and §40.25(j))
Section A: Applicant Disclosure

Per federal regulations, all applicants for safety-sensitive transportation work must disclose their history regarding pre-employment testing for positions they applied for but did not obtain.
Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test where you applied for, but did not obtain, safety-sensitive transportation work in the past three years? *
Refusal to authorize this inquiry prohibits you from operating a CMV for this company.
Section B: Return-to-Duty Verification (Required if "YES" is checked)

If you answered YES, you are strictly prohibited from performing safety-sensitive functions (including operating a CMV) until you have successfully completed the return-to-duty process.
1. Substance Abuse Professional (SAP) Information:
Have you completed an evaluation by a qualified SAP?*
SAP Name:*
2. Education/Treatment Status:
Have you completed the education or treatment program prescribed by the SAP?*
3. Return-to-Duty Testing:
Have you completed a supervised Return-to-Duty drug/alcohol test with a negative result?*
Section C: Authorization & Acknowledgement

Authorization: I hereby authorize Pristine Transport Inc. to make inquiries to any previous employer regarding my drug and alcohol testing history.

Mandatory Refusal: I understand that if I refuse to allow Pristine Transport Inc. to make these inquiries, the company is prohibited by law from permitting me to operate a commercial motor vehicle (CMV).
Certification: I certify that my responses are true and complete. I understand that any false statement or omission of a past violation is grounds for immediate disqualification or termination.
Applicant Signature:*

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Date:*

MonthDayYear
Date

VI. Mandatory Disclosures & Signatures

(Provided in accordance with 49 CFR §391.23 and §391.53)
1. Investigation of Safety Performance History Pristine Transport Inc. is required by federal law to investigate your safety performance history for the three years immediately preceding the date of this application. This inquiry will include:

Employment Verification: Confirmation of your previous driver identification and employment dates.

Accident Record: Details of any accidents as defined in 49 CFR 390.5T.

Drug/Alcohol History: Verification of any violations of alcohol and controlled substances prohibitions under 49 CFR 382 or 49 CFR 40.

2. Your Right to Review and Contest Information Federal regulations grant you specific rights regarding the information provided by previous employers:

The Right to Review: You have the right to review the safety performance information provided by your previous employers.

The Right to Correct Errors: You have the right to have errors in the information corrected by the previous employer and for that employer to re-send the corrected information to Pristine Transport Inc.

The Right to Rebut: You have the right to have a rebuttal statement attached to the alleged erroneous information if you and the previous employer cannot agree on the accuracy of the record.

3. Motor Vehicle Record (MVR) & Annual Review

Initial Pull: We are required to obtain your MVR from every State where you held a license or permit in the past 3 years. This must be placed in your file within 30 days of employment.

Annual Requirement: Pristine Transport Inc. must obtain an updated MVR for you at least once every 12 months to review your safe driving record and confirm no disqualifying offenses have occurred.

4. Drug and Alcohol Testing Disclosure

Pre-Employment Query: You must disclose if you have tested positive, or refused to test, on any pre-employment drug or alcohol test where you applied for, but did not obtain, safety-sensitive transportation work.

Mandatory Refusal: If you refuse to allow Pristine Transport Inc. to make an inquiry into your previous drug and alcohol testing history, we are strictly prohibited by federal law from permitting you to operate a commercial motor vehicle (CMV)

5. Medical & Physical Fitness Disclosure

Medical Certificate: You must be issued a Medical Examiner’s Certificate verifying you meet the physical requirements of 49 CFR 391.41.

National Registry: We are required to verify and document that your Medical Examiner is listed on the National Registry of Certified Medical Examiners.
VII. Authorization & Certification
I, First Name* hereby authorize Pristine Transport Inc. to contact any previous employers and to obtain reports including MVR, PSP, and criminal background for the purpose of evaluating my application. I certify that I have been issued copies of any necessary certificates, such as a road test certificate if required. I certify that this application was completed by me and all information is true and complete.
Applicant Signature:*

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Pristine Transport Inc. | Driver Qualification & Application

Qualification Check

Status: Minimum Age Requirement Not Met

Status: License Requirement Not Met

Status: Medical Certification Required

Safety Compliance Requirement

Status: Major Violation Disqualification

Status: Accident History Requirement Message:

Status: Minimum Experience Not Met

I. Applicant Personal Data

II. License & Experience

III. Employment History (Strict Requirements)

IV. Accident & Violation History (Past 3 Years)

V. SUPPLEMENTAL DRUG AND ALCOHOL DISCLOSURE

Section A: Applicant Disclosure

Section B: Return-to-Duty Verification (Required if "YES" is checked)

1. Substance Abuse Professional (SAP) Information:

2. Education/Treatment Status:

3. Return-to-Duty Testing:

VI. Mandatory Disclosures & Signatures

VII. Authorization & Certification