Interested in getting started with the DRIVER application?

Fill out the form below

Applicant Information
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If at the above residence for less than 3 years, please list all residences for the past 3 years:

Include: Street Address / City / State / Zip
Employment Desired
Position*
*
- Temporary
- Part Time
- Full Time
Referred by
Desired Salary*
Have you ever worked for this company before?*
- Yes
- No
If yes, when and where?
Position
Salary
Reason for leaving
Name/Relationship of any relatives in our employ
Are you employed now?*
- Yes
- No
How long since leaving last employment?
Education
Highest Grade Level Completed*
College*
Last School Attended*
Address*
Military Experience
Have you ever served in the U.S. Armed Forces?*
- Yes
- No
If yes, which branch of service?
Describe any military training received relevant to the position for which you are applying.
Are you currently serving in Military Reserves?*
- Yes
- No
Are you currently serving in National Guard?*
- Yes
- No
General
Have you ever been bonded?
- Yes
- No
Answer only if a job requirement
Name of bonding company
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain
Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.
Driver's License Information
The Federal Motor Carrier Safety Regulations (49CFR391.21 (b) (2) requires that driver applicants state their date of birth and SS #.
Date of Birth*
Month
Day
Year
Social Security Number*
Physical History
The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that driver applicants pass certain physical tests before they are hired to drive a motor vehicle.
Date of last Department of Transportation prescribed examination*
Month
Day
Year
Can you provide a copy?*
- Yes
- No
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?*
- Yes
- No
Alcohol and Controlled Substance Statement
The Federal Motor Carrier Safety Regulations 49CFR340.25 (j) requires all persons with 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 administrated by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?*
- Yes
- No
2) Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administrated by an employer for which you performed safety-sensitive transportation work?*
- Yes
- No
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?*
- Yes
- No
Driver's License Information
Driver licenses held in the past 3 years must be listed:

Include: State / License Number / Type / Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
- Yes
- No
Explain:*
Has any license, permit or privilege ever been suspended or revoked?*
- Yes
- No
Explain:*
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?*
- Yes
- No
Explain:*
Driving Experience
Class of Equipment: STRAIGHT TRUCK
Type of Equipment
(Van, Tank, Flat, Etc.)
Dates
From ___ To ___
Approx. Total Miles
Class of Equipment: TRACTOR AND SEMI TRAILER
Type of Equipment
(Van, Tank, Flat, Etc.)
Dates
From ___ To ___
Approx. Total Miles
Class of Equipment: TWIN
Type of Equipment
(Van, Tank, Flat, Etc.)
Dates
From ___ To ___
Approx. Total Miles
Class of Equipment: OTHER
Type of Equipment
(Van, Tank, Flat, Etc.)
Dates
From ___ To ___
Approx. Total Miles
List states operated in the last 5 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
Accident Review of the past 3 years:

Include: Date / Nature of Accident / # Fatalities / # Injuries / # Vehicles Towed / Citation Issued?
Motor Vehicle Driving Record
Traffic convictions and forfeitures for the past 3 years other than parking violations:

Include: Date / Location / Charge / Penalty
Previous Employment
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
Starting Salary
Ending Salary
Starting Date
Ending Date
Reason for leaving
May we contact your previous employer for a reference?
- Yes
- No
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
Starting Salary
Ending Salary
Starting Date
Ending Date
Reason for leaving
May we contact your previous employer for a reference?
- Yes
- No
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
Starting Salary
Ending Salary
Starting Date
Ending Date
Reason for leaving
May we contact your previous employer for a reference?
- Yes
- No
*
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 release 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 the 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.
*
I acknowledge that all applicants, when called back for offer of employment, will be responsible for paying $28.00 for the Background Check and $55.00 for the Pre-employment Drug Screen. Fees will be reimbursed upon successful completion of the 90 day review.
Signature*
Date*

Interested in getting started with the DRIVER application?

Applicant Information

Employment Desired

Education

Military Experience

General

Driver's License Information

Physical History

Alcohol and Controlled Substance Statement

Driver's License Information

Driving Experience

Accident History

Motor Vehicle Driving Record

Previous Employment