Job Applied For*

First Name*

Middle Name

Last Name*

Social Security No.*

Email Address*

Date of Birth*

Must be 18 years of age or older to apply.

Mobile No*

Other Phone

Street Address*

City*

State*

ZIP*

5-digit ZIP or ZIP+4 (12345-6789)

Country*

Years at this Address*

If at current address less than 7 years, please add previous addresses below.

Name (exactly as on license)*

Maiden / Other Name Used

CDL Class

License Expiration Date*

Must be a future date.

Endorsements

Air Brake Restriction?*

Years of CDL Experience

License Number*

Issuing State*

Current DOT Medical Card?*

Enter months of experience. Leave blank if none.

Dry Van (mo)

Doubles (mo)

Flatbed (mo)

Tanker (mo)

Reefer (mo)

Switching (Yard) (mo)

Dump (mo)

CDL B (mo)

Has any license, permit, or privilege ever been suspended, revoked, or denied?*

Have you ever been convicted for driving under the influence of drugs or alcohol?*

Have you ever tested positive or refused to test on any pre-employment drug and/or alcohol test administered by a DOT-regulated employer during the past 2 years?*

Have you ever been convicted of a felony or misdemeanor?*

DOT requires accurate employment history for the past 10 years. All dates must be in the past.

Are you currently employed?

Employer 1

Current

Company Name*

Position Held

Supervisor Name

Supervisor Phone

Salary / Pay Rate

Street Address

City

State

ZIP

From

To

Reason for Leaving*

Driving / Hauling Experience With This Employer

Hauling What?

Months

Equipment

Subject to FMCSRs?*

Safety-sensitive function (DOT 49 CFR Part 40)?*

Employment Gap (if applicable)

What were you doing during this gap?

From

To

May we contact your current employer?

By submitting this application, I certify that all facts contained herein are true and complete to the best of my knowledge. I understand that, if employed, falsified statements shall be grounds for dismissal.

Under the provisions of the Fair Credit Reporting Act, the Americans With Disabilities Act, the Driver's Privacy Protection Act, and all applicable federal, state, and local laws, I authorize investigation of all statements contained herein. I also authorize the references and employers listed to provide any and all information concerning my previous employment and any pertinent information they may have.

I hereby release and hold harmless any person, firm, or entity that discloses information in accordance with this authorization, as well as my prospective employer and its agents, from any liability resulting from such disclosure.

I consent to completing this application and background investigation process electronically. My electronic signature has the same legal effect as a handwritten signature.

I acknowledge and consent to the following:

Electronic signature and application process*Inquiry to previous employers*Previous employer inquiry for driving history & safety performance*PSP consent form*Release of information form*Disclosure and authorization form*Pre-employment controlled substance testing*

Print Name (Electronic Signature)*

Draw Your Signature*

Sign using your mouse, trackpad, or finger on touch devices.

Verify you are human*

By submitting, you electronically sign this application and all associated disclosures. This constitutes a legally binding signature.

CDL Driver Application