Driver Application Applicant Information Full Name Current Address City, State/Province, Zip Country Have you lived here 3 years or more? YesNo SSN/SIN Date of Birth Primary Phone Email Consent to receive email communications? YesNo Consent to receive text messages? YesNo Position & Equipment Position Applying For Company Driver or Owner Operator or Sub-Contractor Company DriverOwner OperatorSub-Contractor Equipment Details Type Year Make Model Color VIN Weight Mileage Fifth Wheel Height Eligibility & Language Location Applying For Eligible to work in the U.S.? YesNo Currently Employed? YesNo Last Employment End Date Can Read/Write/Speak English? YesNo Worked here before? YesNo TWIC Card? YesNo TWIC Expiration Used other names? YesNo If yes, enter name Referral Source Referral Name (if driver) Driving Experience Straight Truck None1-2 yrs3-5 yrs6+ yrs Tractor/Semi-Trailer None1-2 yrs3-5 yrs6+ yrs Tractor - Two Trailers None1-2 yrs3-5 yrs6+ yrs License Info License Number Issuing State Country Class Expiration Date DOT Medical Expiration Commercial Driver License? YesNo Endorsements TankerHAZMATDoubles/TriplesOther Employment History Previous Employer Company Name Start Date End Date Address Phone Position Held Reason for Leaving Still Employed? YesNo May we contact? YesNo -+ Vehicle Accident Record Any accidents in the past 3 years? YesNo Describe (if yes) Traffic Convictions/Violations Have you ever been convicted of a crime? YesNo Do you have any deferred prosecutions? YesNo Do you have any criminal charges pending? YesNo Have you ever pled “guilty”, been convicted of, or pled “no contest” to a felony? YesNo If you have any felony convictions, do you currently hold a minister’s permit to enter/exit Canada? YesNo In the last five years, have you pled “guilty”, been convicted of, had prosecution deferred, or pled “no contest” to a misdemeanor? YesNo Any convictions in the last 3 years? YesNo Describe (if yes) Legal Declarations I understand that any misrepresentation or omission may be cause for dismissal.I authorize investigation of all statements contained in this application.I consent to a background and driving record check.I have read and agree to the terms listed above. Upload Files Upload CDL/Resume (PDF only) Signature Type your full name as signature Date FMCSA / DOT Compliance Questions Are you currently disqualified from driving a commercial motor vehicle under FMCSR 391.15? YesNo Has your license, permit, or privilege to drive ever been suspended or revoked for any reason? [49 CFR 391.21(b)(9)] YesNo Have you ever been denied a license, permit, or privilege to operate a motor vehicle? [49 CFR 391.21(b)(9)] YesNo Within the past two years, have you tested positive or refused a pre-employment drug/alcohol test for a DOT safety-sensitive job? [49 CFR 40.25(j)] YesNo In the past three years, have you been convicted of any of the following? (select all that apply) BAC of .04 or more while driving commercial vehicleDUI (alcohol) per state lawRefused drug/alcohol testDUI on Schedule I drugs or narcoticsTransport/possession of controlled substances while on dutyLeaving scene of an accident with commercial vehicleFelony involving a commercial motor vehicle Legal Acknowledgements (FCRA / PSP / DOT) I acknowledge that I have read and understand the federal FCRA Summary of Rights and agree to sign electronically. I acknowledge that I have read and understand the PSP Disclosure and Authorization and agree to sign electronically. I acknowledge that I have read and understand the CRADIS notice and agree to sign electronically. I acknowledge the DOT Drug and Alcohol Release and agree to sign electronically. I acknowledge the FMCSA Clearinghouse Release and agree to sign electronically. I acknowledge and understand the Investigative Consumer Report Disclosure. I understand and agree to all the above document disclosures.
