DRIVER’S APPLICATION FOR EMPLOYMENT

APPLICANT TO COMPLETE

(answer all questions)

Name 

List your addresses of residency for the past 3 years.

Current Address  

Previous Addresses

Dates

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 addi- tional 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.)

EMPLOYER

EMPLOYER

EMPLOYER

EMPLOYER

EMPLOYER

*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

EXPERIENCE AND QUALIFICATIONS – DRIVER

List all driver licenses or permits held in the past 3 years

DRIVER LICENSES

DRIVING EXPERIENCE CHECK YES OR NO

CLASS OF EQUIPMENT

EXPERIENCE AND QUALIFICATIONS – OTHER

EDUCATION

LAST SCHOOL ATTENDED   

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.