Commercial Driver Job Application

    Applicant Name

    *Last:

    *First:

    *Middle:

    *Email:

    *Primary Phone:

    Alternate Phone:

    If at the above residence less than three years, list below all residences for the past three years.

    Position Applied For:

    SeasonalPart TimeFull Time

    Who Referred You?

    Rate of Pay Expected?

    Have you ever worked for this company before? YesNo

    Date (from):

    Date (to):

    Where:

    Rate of Pay:

    Position:

    Are you currently employed?

    If not, how long since leaving last employment?

    Education

    Highest grade completed:

    College:

    Military Experience

    Have you ever served in the U.S. Armed Forces? YesNo

    If yes, which branch of service:

    Are you currently serving in Military Reserves? YesNo

    Are you currently serving in National Guard? YesNo

    General

    Have you ever been bonded?

    Name of bonding company?

    (Answer only if a job requirement)

    If yes, please explain below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

    Driver Experience and Qualifications

    The Federal Motor Carrier Safety Regulations (49CFR391.21 (b) (2) requires that driver applicants state their date of birth and SS #.

    Date of Birth

    Social Security Number?

    Physical History

    The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.

    Date of last Department of Transportation prescribed examination

    Can you provide a copy?

    Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of foot, leg, hand or arm?

    Alcohol and Controlled Substance Statement

    The Federal Motor Carrier Safety Regulations 49CFR40.25(j) requires all persons applying for a driving position requiring a commercial drivers license to answer the following questions:

    1) Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

    2) Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?

    3) If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

    Applicants Signature:

    Date:

    Driver's License Information

    A) Have you ever been denied a license, permit or privilege to operate a motor vehicle?

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

    C) Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? If you answered “Yes” to A, B, or C, attach a statement giving details.

    Statement For The Above Question:

    Driving Experience

    List states operated in during the last five years:

    List special courses or training that will help you as a driver:

    List safe driving awards held and who awards were presented by:

    Accident History

    Motor Vehicle Driving Record (MVR)

    Traffic Convictions and Forfeitures for the past 3 years other than parking violations.

    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:

    Phone:

    Position held:

    Salary:

    From:

    To:


    Previous Employer:

    Supervisor’s Name:

    Address:

    Phone:

    Position held:

    Salary:

    From:

    To:


    Previous Employer:

    Supervisor’s Name:

    Address:

    Phone:

    Position held:

    Salary:

    From:

    To:


    Previous Employer:

    Supervisor’s Name:

    Address:

    Phone:

    Position held:

    Salary:

    From:

    To:


    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.

    Signature:

    Date: