Application Form for Commercial Drivers

Step 1/3

This transportation company is an equal opportunity employer in compliance with all Federal and State equal employment opportunity laws. Consideration of qualified applicants for any position is made without regard to the applicant’s sex, race, color, national origin, marital status, age, religion or non-job related disability.

Can you legally be employed in the United States?

Do you have proof of age?

Have you even been employed by this company before?

Have you ever tested positive for a pre- employment or random Drug or Alcohol test in the past two years?

Employment history-past 3 years

Step 2/3

Drivers who desire to drive in interstate commerce must provide the following information on all employers during the previous three years. Start with the most recent. You must give the same information for all employers you have driven a commercial vehicle for the seven years prior to the initial three years (total of ten years employment record). Use additional sheets if necessary and please explain any employment gaps.

Current or last employer

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?

Were you subject to the FMCSRs while employed?

Second last employer

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?

Were you subject to the FMCSRs while employed?

Third last employer

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?

Were you subject to the FMCSRs while employed?

Fouth last employer

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?

Were you subject to the FMCSRs while employed?

MVR Request Form

Step 3/3

Carefully Read Tthe Following and Sign Below

By signing the statement, I certify that this application has been completed by me, and all of the entries provided are true, complete, and accurate, to the best of my knowledge. By signing below, I also authorize this company to make such inquires into my employment, financial, personal, or medical history as might be needed to make an employment decision. I understand that inquiries into my medical history are generally made after a job offer is made.