Driver's Application for Employment
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, veteran status, non-job related disability, or any other protected group status.
TO BE READ AND SIGNED BY APPLICANT
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 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 inter-view(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
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 49 CFR 391.23(d) and (e). I understand that I have the right to:
List your addresses of residency for the past 3 years.
If you need to provide additional information, please provide it at the end of this application, in the "additional information" section. You may also upload any additional documents or files there as well.
Do you have the legal right to work in the United States?
Date of Birth Can you provide proof of age?
Have you worked for this company before?
Are you currently employed?
Have you ever been convicted of a felony?
If yes, please explain fully below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?
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 vehicle.(NOTE: List employers in reverse order starting with the most recent.)
Previous Employer #1 (most recent)
WERE YOU SUBJECT TO THE FMCSRs✝ WHILE EMPLOYED?
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
Previous Employer #2
Previous Employer #3
Previous Employer #4
Previous Employer #5
Previous Employer #6 (oldest)
*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
✝ The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding
ACCIDENT RECORD FOR PAST 3 YEARS OR MOREIf none, simply write "NONE" in first box
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)If none, simply write "NONE" in first box
EXPERIENCE AND QUALIFICATIONS – DRIVERList all driver licenses or permits held in the past 3 years
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? YesNo
Straight Truck YesNo
Tractor and Semi-trailer YesNo
Tractor - Two Trailers YesNo
Tractor - Three Trailers YesNo
Motorcoach - School Bus (8+ passengers) YesNo
Experience and Qualifications - Other
Select level of schooling completed8th grade or lower9th grade10th grade11th gradehigh school graduate1 year of college2 years of college / Associate degree3 years of college4 years of college / Bachelor's degree5+ years of collegeMasters or PhD degree (or equivalent)
My signature below 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.
Leave this empty:
Your legal name
If you have questions about the contents of this document, you can email the document owner.
Document Name: Driver's Application for Employment
Agree & Sign