Driver’s Application for Employment

Driver's Application for Employment

Step 1 of 4

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such a vehicle.

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Note: List employers in reverse order starting with the most recent.

Current Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Employer

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Person

Position Held

Salary/Wage

Reason for Leaving

Qualifications and Experience - Other

Show any trucking, transportation or other experience that may help in your work for this company

List courses and training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

TO BE READ AND SIGNED BY APPLICANT

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.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)

I hereby release employer, 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 understand, also, that I am required to abide by all rules and regulations of the Company.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status or non-job related disability.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23(d) and (e). I understand I have the right to:

• Review information proved by previous employers:
• Have errors in the information corrected by previous employers and for those previous employers to re-send 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.

Date(Required)

Applicant's Signature(Required)

Type in your name as your signature.

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