Driver's Application For Employment

Applicant To Complete

(answer all questions - please print)



List your addresses of residency for the past 3 years.

Current Address

Previous Addresses

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.
(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)



   
   


Employment History (continued)


   
   


*includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more, passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.


Use This Sheet for Additional Employment History Information (continued)


   
   


*includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more, passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.



Accident Record for past 3 years or more ( Attach sheet if more space is needed) If none, write none

Traffic conviction and forfeitures for the past 3 years (other than parking violations) If none, write none


(Attach sheet if more space is needed)

Experience and qualifications - Driver



Driver licences or permits held in the past 3 years


   
   


Driving Experience (check yes or no)
   
   
   
   
   
   
   


Experience and qualifications - Other

Education

               
       
       

To be read and signed by applicant

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.