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 decided) 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
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, 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 investigation my safety performance history as required by 49 cfr 391.23(d) and (e), I understand that I have the right to:
• Review information provided by previous employer,
• 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.
Please provide us with addresses to show the last 3 years of residency.
Would you like to upload a resume?
EMPLOYMENT HISTORY- MUST GO BACK 10 YEARS
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 5 years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten years employment record)
You are required to list the complete mailing address, street number and name, city, state and zip code.
Were you subject to 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
Was there a time gap between this employment and your last employment?
*Any gaps in employment and/or unemployment must be explained.
** 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 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
Do You Have Any Driving Experience?
Have You Had Any Accidents In The Last 3 Years?
Accident Information (List All For Last 3 Years)
Your digital signature below certifies that this application was completed by you, and that all entries on it and information in it are true and complete to the best of your knowledge.
Please attach the completed authorization form here.