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Employment History
Give a complete record of all employment including any unemployment or self-employment for the past 3 years, and all commercial driving experience for the past 10 years.
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Was your position considered a safety-sensitive DOT-Regulated function subject to controlled substance and alcohol testing requirements?
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Dates Employed FROM:
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Month
-
Day
Year
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TO:
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Month
-
Day
Year
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Were you subject to the FMCSR's while employed with this company?
Yes
No
Was your position considered a safety-sensitive DOT-Regulated function subject to controlled substance and alcohol testing requirements?
Yes
No
Next Previous Employer
Address
Street Address
Street Address Line 2
City
State / Province
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Please Select
United States
Afghanistan
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Algeria
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Angola
Anguilla
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Brazil
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Canada
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Chad
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China
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Colombia
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Croatia
Cuba
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Denmark
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Mali
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Martinique
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Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
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Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Dates Employed FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
Were you subject to the FMCSR's while employed with this company?
Yes
No
Was your position considered a safety-sensitive DOT-Regulated function subject to controlled substance and alcohol testing requirements?
Yes
No
Next Previous Employer
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Dates Employed FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
Were you subject to the FMCSR's while employed with this company?
Yes
No
Was your position considered a safety-sensitive DOT-Regulated function subject to controlled substance and alcohol testing requirements?
Yes
No
Driving Experience
Straight Truck
*
Yes
No
Dates operated FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
Tractor and Semi-Trailer
*
Yes
No
Dates operated FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
Tractor Doubles/Triples
*
Yes
No
Dates operated FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
Other Tanker/Flatbed/Specialized
*
Yes
No
Dates operated FROM:
-
Month
-
Day
Year
Date Picker Icon
TO:
-
Month
-
Day
Year
Date Picker Icon
List states operated in for the past 5 years
States
*
Special Courses
List any special courses and or training completed (HazMat, PTD/DDC, etc.)
List any safe driving awards you earned and from whom
Accident Record
Date of accident
-
Month
-
Day
Year
Date Picker Icon
Nature of accident (rear-end, lane change, etc.)
State and City
Number of fatalities
Number of injuries
Date of accident
-
Month
-
Day
Year
Date Picker Icon
Nature of accident (rear-end, lane change, etc.)
State and City
Number of fatalities
Number of injuries
Traffic convictions and forfeitures for the past 3 years (Do not include parking violations)
Date
-
Month
-
Day
Year
Date Picker Icon
State and City
Charges
Penalty
Date
-
Month
-
Day
Year
Date Picker Icon
State and City
Charges
Penalty
Answer Yes or No to the following questions
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Has any license, permit, or privilege ever been suspended or revoked?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Have you tested positive or refused a DOT controlled substance or alcohol pre-employment screening within the last two years from an employer who did not hire you?
Yes
No
If the answer to any of the above is "Yes", give details
Agreement
To be Read, Understood and Signed by the Driver Applicant
It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is also a violation of 49 CFR 390.35 - Making fraudulent or intentionally false statements or records, which is subject to federal penalty by the Federal Motor Carrier Safety Administration. It is agreed and understood that the motor carrier 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 persons named herein from all liability for any damages on account of his furnishing such information. 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 investigating Consumer Report, including information regarding my character, general 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 application file. It is agreed and understood that this driver application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
By typing your full name in the box below you are agreeing to digitally sign this document and conduct the application process by electronic means.
Applicants Full Name
*
Date
*
-
Month
-
Day
Year
Date Picker Icon
E-mail address
A valid email address is required, Additional forms will be sent to this address.
Additional signatures are required. You will be provided copies of this agreement and additional documents requiring signatures in an electronic mail.
Enter the message as it's shown
*
Submit
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