Driver Qualification File

Driver Qualification File

Complete all required driver, company, licensing, experience, education, and employment history information online.
Applicant Information
Driver Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
License Number
License State
Date of Hire

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Company Name
Email Address
example@example.com
Phone Number
Social Security Number
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Available to Start Work

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Applied for:
Do you have legal right to work in the US?
Previous 3 Years of Residency History
Current Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address
Previous Address
Previous Address
Drivers License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have morethan one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years;
Current License State
Current License Number
Current License Type/Class
Current License Endorsements
Current License Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Previously Held Licenses
Driver Experience
Class/Type of Equipment, Date of Experience, & Approx # of Miles Driven
Accident Record

Other (Please Explain Further)
Traffic Convictions

Other (Please Explain Further)
Required Safety / Legal Questions
Ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privilege ever been suspended or revoked?
Ever been convicted of any criminal act involving the use of a CMV or while driving a CMV?
Ever been convicted of any law violation, other than a minor traffic violation?
Explanation For Any Yes Answers
Iff answered ‘Yes’ to ANY of the above 4 questions, applicant MUST provide further explanation.
Education History
Highest Level of Education

Other
Other Qualifications/Notes
Employment History
Current/Most Recent Employer
Business Name
Name of Supervisor
Employment Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Employment End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Format: (000) 000-0000.
May We Contact?
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Position
Salary
Reason for Leaving / Explain Any Gaps
Employed in a safety-sensitive function subject to DOT drug and alcohol testing?
Subject to Federal Motor Carrier Safety Regulations?
Previous Employer 1
Business Name
Name of Supervisor
Employment Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Employment End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Format: (000) 000-0000.
May We Contact?
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Position
Salary
Reason for Leaving / Explain Any Gaps
Employed in safety sensitive function subject to DOT Drug & Alcohol testing?
Subject to Federal Motor Carrier Safety Regulations?
Previous Employer 2
Business Name
Name of Supervisor
Employment Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Employment End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Format: (000) 000-0000.
May We Contact?
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Position
Salary
Reason for Leaving / Explain Any Gaps
Employed in safety sensitive function subject to DOT Drug & Alcohol testing?
Subject to Federal Motor Carrier Safety Regulations?
To Be Read And Signed By Applicant
I authorize you to make investigations (including contacting current and prior employers) into my personal, employment,
financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby
release employers, schools, health care providers, and other persons from all liability in responding to inquiries and
releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may
result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.
I understand that the information I provide regarding my current and/or prior employers may be used, and those
employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23.
I understand that I have the right to:
• Review information provided by current/previous employers;
• Have errors in the information corrected by previous employers, and for those previous employers to resend the
corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree
on the accuracy of the information.
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.
Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor
Carrier Safety Regulations.
Fair Credit Reporting Act Disclosure Statement
In accordance with the provisions of Section 604 (b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended
by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed
that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be
obtained on you for employment purposes. Your employer may obtain this information from Equifax, TransUnion, Experian
or other vendors of information services.
Certification of Compliance With Driver License Requirements
MOTOR CARRIER INSTRUCTIONS:
The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and
operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials
that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing
10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS:
Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must
comply with. These requirements are in effect as of July 1, 1987. They are as follows:

1. You, as a commercial vehicle driver, may not possess more than one license.
2. If you currently have more than one license, you should keep the license from your state of residence, and return
the additional licenses to the states that issued them. Destroying a license does not close the record in the state
that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, you should close
your record by notifying the state of issuance that you no longer want to be licensed by that state.
3. Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer
the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In addition, Section 383.31 requires
that any time you violate a state or local traffic law (other than parking), you must report it to your employing motor
carrier and the state that issued your license within 30 days.

DRIVER CERTIFICATION:
I certify that I have read and understand the above requirements.
The license stated earlier in the application as the current license will be the only one I possess:
Driver Statement of On-Duty Hours
INSTRUCTIONS:
Motor carriers, when using a driver for the first time, must obtain from the driver a signed statement giving the total time
on-duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to
beginning work for the carrier, as required by Section 395.8( j)(2) of the Federal Motor Carrier Safety Regulations.

This form should be completed on the day the driver is scheduled to begin driving a commercial motor vehicle, and must
be kept on file for at least 6 months.
I hereby certify that the information given above is correct to the best of my knowledge and belief and that I was lastrelieved from work at:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate Relieved from Work
Time Relieved from Work MinutesAM/PM Option
Driver Certification for Other Compensated Work
I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.
Are you currently working for another employer?
At this time do you intend to work for another employer while still employed by this carrier?
In conjunction with my potential employment at First Time Logistic LLC ("the company"), I your name (applicant) consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company.

This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act.
Applicant Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

Driver Qualification File

Applicant Information

Previous 3 Years of Residency History

Drivers License Information

Required Safety / Legal Questions

Education History

Employment History

Current/Most Recent Employer

Previous Employer 1

Previous Employer 2