Commercial Driver Application for Employment

Commercial Driver Application for Employment

DRIVER EXPERIENCE AND QUALIFICATIONS

DRIVER EXPERIENCE AND QUALIFICATION (continued)

APPLICANT MUST READ AND SIGN

EDUCATION

MILITARY EXPERIENCE

GENERAL

PHYSICAL HISTORY

ALCOHOL AND CONTROLLED SUBSTANCE STATEMENT

DRIVER'S LICENSE INFORMATION

DRIVING EXPERIENCE

ACCIDENT HISTORY

MOTOR VEHICLE DRIVING RECORD (MVR)

EMPLOYMENT RECORD

DRIVER EXPERIENCE AND QUALIFICATION (continued)
ACCIDENT HISTORY

MOTOR VEHICLE DRIVING RECORD (MVR)
Traffic Convictions and Forfeitures for the past 3 years other than parking violations.

MOTOR VEHICLE DRIVING RECORD (MVR) Traffic Convictions and Forfeitures for the past 3 years other than parking violations.

Rows	Date	Location	Charge	Penalty
1
2

EMPLOYMENT RECORD
The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.
Start with the last or current position, including any military experience, and work back. You are required to list the complete mailing address: street number, city, state and zip code.
Current Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:
Previous Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:
Previous Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:
Previous Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:
Previous Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:
Previous Employer:
Supervisor's Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Position Held:
From Mo. /Yr.
To Mo. /Yr.
Salary
Reason for Leaving:

APPLICANT MUST READ AND SIGN
I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.
I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.
If hired, I agree to abide by all the rules and policies of the employer.
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.
Date

MonthDayYear
Date
Applicant's Signature
Should be Empty:

Rows	State	License Number	Type	Expiration Date
Licenses held
in past 3
years must
be shown

Rows	From To	Column 3
Straight Truck
Tractor and Semi-Trailer
Twin
Other

Nature of Accident (Head-On, Rear-End, Upset, etc)

# Fatalities

# Injuries

# Vehicles Towed

Citation Issued?