Application for Employment
* If at current address less than 5 years, list below most recent addresses for the past 5 years. (Click on the "Add Previous Address" button to add additional Previous Addresses.)
Commercial Driver's License
Driving/Hauling Experience
How many years experience with each type of equipment.Education
High School
College
Trade or Business School
Additional Licenses
List ALL additional licenses held in the past 5 years and ALL unexpired commercial motor vehicle operator's licenses or permits.
(Click on the "Add License" button to add additional Licenses.)
DO NOT enter current license information in this section.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 an employer to which you applied for but did not obtain safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years? *
Have you ever been convicted of a felony or misdemeanor? *
Accident Review for Past 5 Years
If no accidents to report, you must click the button below.
Click on the "Add Accident" button to add additional Accidents.
Traffic Convictions & Forfeitures for Past 5 Years
If no Traffic Convictions or Forfeitures to report, you must click the button below.
Click the "Add Conviction or Forfeiture" button to add Traffic Convictions or Forfeitures.
Employment History
You must provide accurate dates of employment and phone numbers covering the last ten years (per DOT regulation).
We cannot hire you without verifying employment.
If you need to list additional employers, click "Add Employment" button below.
Employment Gap
Authorization
By clicking "Send" below, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, any falsified statements on this application shall be grounds for dismissal. Under the provisions of the Fair Credit Reporting Act, the Americans With Disabilities Act, the Drivers Privacy Protection Act and all other applicable federal, state, and local laws I authorize investigation of all statements contained herein as well as authorize the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise.
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 that may otherwise result from the request for, use of, or disclosure of, any or all of the foregoing information. The above-mentioned investigations may include, but are not limited to, information as to my character, general reputation, work history, or lifestyle, discerned through employment and education verifications; personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history records; or any other public record.
I understand that consumer reports which may contain public record information may be requested, at the discretion of my prospective employer, which may include names, dates of employment, reason for termination, work experience, traffic records, workers compensation claims, etc. I have the right, under the provisions of the Fair Credit Reporting Act and the Drivers Privacy Protection Act to request all such information from the reporting agency, upon proper identification, and to request the nature and substance of all information; and the receipt of any reports on me, which the reporting agency has, or will, furnish for the two preceding years. I am also entitled to a copy of my consumer rights under the Fair Credit Reporting Act. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.
