(answer all questions - please print)
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.)
*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.
(Attach sheet if more space is needed)
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.