Driver Application circlebar11/25/2020 Posted 3 years ago Apply Online Applicant InformationFirst Name*Middle Name*Last Name*Phone*A valid phone number is required. Email*A valid email address is required.Date of Birth*Position Applying for*Date Available to Start*Previous 3 Years ResidencyCurrent Address (Street, City, State, Zip)*Years at Current Residence*Mailing Address (Street, City, State, Zip)*First Previous Residence (Street, City, State, Zip)Years at First Previous ResidenceSecond Previous Residence (Street, City, State, Zip)Years at Second Previous ResidenceThird Previous Residence (Street, City, State, Zip)Years at Third Previous ResidenceCurrent License InfoState*Type/Class*Endorsements*Expiration*Previous License 1State Type/Class Endorsements Expiration Previous License 2State Type/Class Endorsements Expiration Driving Experience 1Equipment Class* Straight Truck Tractor & Semi-Trailer Tractor & Two Trailers Tractor & Tanker Other Type of Equipment (Truck, Van, Flat, etc.)*Start Date*End Date*Approx. # of Miles*Driving Experience 2Equipment Class * Straight Truck Tractor & Semi-Trailer Tractor & Two Trailers Tractor & Tanker Other Type of Equipment (Truck, Van, Flat, etc) Start Date End Date *Approx. # of Miles Driving Experience 3Equipment Class Straight Truck Tractor & Semi-Trailer Tractor & Two Trailers Tractor & Tanker Other Type of Equipment (Truck, Van, Flat, etc) Start Date End Date Approx. # of Miles Accident Record Past 3 YearsHave you had any accidents in the last 3 years?*No Yes (list details below) Accident 1 DateAccident Details (head-on, rear-end, etc)# Fatalities# InjuriesChemical Spills?Yes No Accident 2 Date Accident Details (head-on, rear-end, etc) # Fatalities # Injuries Chemical Spills? Yes No Accident 3 DateAccident Details (head-on, rear-end, etc_ # Fatalities # Injuries Chemical Spills? *Yes No TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)Have you had any convictions in the last 3 years?*No Yes (list details below) Date Convicted 1ViolationState of ViolationPenalty (Forfeited bond, collateral, etc.)Date Convicted 2 Violation State of Violation Penalty (Forfeited bond, collateral, etc.) Date Convicted 3 State of Violation Penalty (Forfeited bond, collateral, etc.) Have you ever been denied a license, permit, or privilege to operate a motor vehicle? ☐ YES ☐ NO If yes, explain*Yes No If yes, explain:Has any license, permit, or privilege ever been suspended or revoked? ☐ YES ☐ NO If yes, explain*Yes No If yes, explain: Employment History: Federal Motor Carrier Safety Regulations (49 CFR 391.21) require applicants for commercial drivers list all employment for the last 3 years, plus 7 years if you’ve driven commercial previously.Current Employer*Phone *A valid phone number is required. Address (City, State, Zip)*Position Held*Start Date End Date *Salary*Reason for Leaving*Explain Any Gaps in EmploymentSecond Recent EmployerPhone *A valid phone number is required. Address (City, State, Zip) Position Held Start Date End Date Salary Reason for Leaving Explain Any Gaps in Employment Third Recent EmployerPhone A valid phone number is required. Address (City, State, Zip) Position Held Start Date End Date Salary Reason for Leaving Explain Any Gaps in Emplyement EducationGraduated High School*Yes No Name and LocationCourse of StudyDetailsGraduated College*Yes No Name and Location Course of Study Details Other education*Yes No ExplainOther QualificationsAttach Resume* Submit
