Driver Application

DRIVER EMPLOYMENT APPLICATION
Please provide complete answers to all questions. Incomplete answers will only slow or stall the application process.
Applicant Name*

First NameMiddle Name / Initial (optional)Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
name@example.com
Date of Birth*

MonthDayYear
Social Security Number*
Numbers Only
Have you lived at the address above for (3) years or more?*

YesNo
Please list your past (3) years of residency.
House Number, Street Name, City, State, & Zip
Have you ever been known by any other name?*

YesNo
Please list the other names.
Driver's License Information
Have you held a valid U.S. driver's license for the past (3) years?*

YesNo
Please explain.
Driver's License Number*
State of Issue*
License Expiration Date*

MonthDayYear
License Class*
License Restriction*

Yes (Automatic Only)No
CDL Endorsements*

NoneX EndorsementHazmatTriples / DoublesTankerTWIC
Have you held any licenses in other states within the past (5) years?*

YesNo
Please list licenses held in any other state within the past (5) years.
Please include license number information if possible.
Did you attend or graduate from a trucking school?

YesNo
Please provide your trucking school information.
Please provide as much information as possible including name, location, dates attended and graduated.
Are you at least (21) years of age and have (1) year of commercial driving experience?*

YesNo

Please list any accidents within the last (3) years.

Rows	Date (most recent first)	Nature of Accident (head-on, rear-end, upset, etc.)	# of Fatalities	# of Injuries	Chemical Spills
1
2
3

Please list any traffic convictions or forfeitures within the last (3) years. (Other than parking violations.)

Rows	Date (most recent first)	Violation (speeding, not wearing seat belt, not yielding to traffic device, etc.)	State of Violation	Penalty (suspension, fines, and/or points)
1
2
3

Has any license, permit, or privilege ever been suspended or revoked?*

YesNo
Please explain.
Employment History
The Federal Motor Carrier Safety Regulations (49 CFR 391.21) 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 in excess of one (1) month must be explained.

Start with your current or most recent position, including any military experience, and work backwards (you can upload supportive attachments if necessary by scrolling to the bottom of this form). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.
Employer 1
Company Name*
Current or most recent.
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this your current employer?*

YesNo
Position Held*
Start Date*

MonthDayYear
Ending Date*

MonthDayYear
If current employer, please select today's date.
Was this a driving position?

YesNo
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YesNo
Was the position designated as a safety-sensitive function in any Department of Transportation regulated mode subject to alcohol and controlled substances testing as required by Title 49 CFR, part 40?

YesNo
Type of Truck
Type of Trailer
Trailer Length
Number of States Driven
Reason for leaving?*
Explain any gaps in employment.
Please include month, year, & reason.
Employer 2
Company Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Position Held
Start Date

MonthDayYear
Ending Date

MonthDayYear
Was this a driving position?

YesNo
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YesNo
Was the position designated as a safety-sensitive function in any Department of Transportation regulated mode subject to alcohol and controlled substances testing as required by Title 49 CFR, part 40?

YesNo
Type of Truck
Type of Trailer
Trailer Length
Number of States Driven
Reason for leaving?
Explain any gaps in employment.
Please include month, year, & reason.
Employer 3
Company Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Position Held
Start Date

MonthDayYear
Ending Date

MonthDayYear
Was this a driving position?

YesNo
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

YesNo
Was the position designated as a safety-sensitive function in any Department of Transportation regulated mode subject to alcohol and controlled substances testing as required by Title 49 CFR, part 40?

YesNo
Type of Truck
Type of Trailer
Trailer Length
Number of States Driven
Reason for leaving?
Explain any gaps in employment.
Please include month, year, & reason.
Education
High School (or equivalent)
School Name
School Location
City, State
Did you graduate?

YesNo
If No, years completed?
College
College Name
College Location
City, State
Did you graduate?

YesNo
Highest Degree Awarded
If No, years completed?
Other Qualifications
Please list any other qualifications or skills that you believe should be considered.
Additional Questions
If hired, can you provide proof you are eligible to work in the U.S.? (ex: Birth Certificate, Valid ID, SS Card, etc)*

YesNo
Have you ever had a DUI, DWI, or OVI?*

YesNo
If Yes, please provide dates, county, city, state, jail time, and any fines received.
Note: We must have complete information to satisfy carrier insurance requirements.
Has your license ever been suspended?*

YesNo
If Yes, please provide county, city, state, dates, length of suspension, and the reason why.
Have you ever been convicted of a felony?*

YesNo
If Yes, please provide dates, city, county, state, nature of offense, jail time, and any fines received.
Note: We must have completed information to satisfy carrier insurance requirements.
Have you ever been convicted of a misdemeanor?*

YesNo
If Yes, please provide dates, city, county, state, nature or offense, jail time or probation, and any fines received.
Note: We must have completed information to satisfy carrier insurance requirements.
Are you covered by a non-compete agreement with another company?

YesNo
Have you ever had a positive drug or alcohol pre-employment test result?

YesNo
Have you ever refused to submit a drug or alcohol test?

YesNo
Have you ever had a positive drug or alcohol result of random testing?

YesNo
If Yes, what was the date of rehab completion under direction of a SAP (Substance Abuse Professional) / MRO (Medical Review Officer)?

MonthDayYear
Were you referred to our company by an employee of Laudick Trucking, Inc.?

YesNo
If Yes, who?

First NameLast Name
References

Please provide (3) references.
Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Title / Relationship
Number of Years Known
Reference 2
Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Title / Relationship
Number of Years Known
Reference 3
Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Title / Relationship
Number of Years Known
Upload Files
Click to Browse Files and upload your resume, cover letter, and/or any supporting documents.

Only pdf, doc, docx, and txt files are supported.
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Disclosure Statement and Agreement
Signature*
Should be Empty:

Driver's License Information

Employment History

Employer 1

Employer 2

Employer 3

Education

Additional Questions

References

Reference 2

Reference 3

Upload Files

Disclosure Statement and Agreement