Driver Employment Application

Driver Employment Application

Please complete all sections with accurate information. Use a clean web form layout optimized for desktop and mobile.
Applicant & Position Information
Full Name

First NameLast Name
Street Address
City
State
ZIP Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Social Security Number
Date of Application

MonthDayYear
Date
Position Applied For
Date Available for Work

MonthDayYear
Date
Legal right to work in the United States
Residence History
Current Residence Street
Current Residence City
Current Residence State
Current Residence ZIP
Current Residence Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address Street, City, State, ZIP, and Years at Address
Driver’s License Information
Current License State
Current License Number
Current License Type/Class
Current License Endorsements
Current License Expiration Date

MonthDayYear
Date
Driving Experience
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approx. Miles (Total)
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approx. Miles (Total)
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approx. Miles (Total)
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approx. Miles (Total)
Type of Equipment
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Approx. Miles (Total)
Traffic Convictions
No traffic convictions in past 3 years
Conviction Date 1

MonthDayYear
Date
Violation 1
State of Violation 1
Penalty 1
Conviction Date 2

MonthDayYear
Date
Violation 2
State of Violation 2
Penalty 2
Conviction Date 3

MonthDayYear
Date
Violation 3
State of Violation 3
Penalty 3
License Denials/Suspensions
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privilege ever been suspended or revoked?
If yes, explain the circumstances for any license denial, suspension, or revocation.
Please provide any additional details related to license denials or suspensions.
Employment History
Employer 1 Name
Employer 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 1 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 1 Position Held
Employer 1 From

MonthDayYear
Date
Employer 1 To

MonthDayYear
Date
Employer 1 Salary
Employer 1 Reason for Leaving
Employer 1 Subject to Federal Motor Carrier Safety Regulations?
Employer 1 Safety-Sensitive Function Subject to DOT Alcohol and Controlled Substances Testing?
Employer 2 Name
Employer 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 2 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 2 Position Held
Employer 2 From

MonthDayYear
Date
Employer 2 To

MonthDayYear
Date
Employer 2 Salary
Employer 2 Reason for Leaving
Employer 2 Subject to Federal Motor Carrier Safety Regulations?
Employer 2 Safety-Sensitive Function Subject to DOT Alcohol and Controlled Substances Testing?
Employer 3 Name
Employer 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 3 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 3 Position Held
Employer 3 From

MonthDayYear
Date
Employer 3 To

MonthDayYear
Date
Employer 3 Salary
Employer 3 Reason for Leaving
Employer 3 Subject to Federal Motor Carrier Safety Regulations?
Employer 3 Safety-Sensitive Function Subject to DOT Alcohol and Controlled Substances Testing?
Explain Any Gaps in Employment
Education
Education Entries
Instructions
Applicant Certification & Signature
Applicant Name (Printed)

First NameLast Name
Applicant Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Driver Employment Application

Applicant & Position Information

Residence History

Driver’s License Information

Driving Experience

Traffic Convictions

License Denials/Suspensions

Employment History

Education

Applicant Certification & Signature