Driver Application

  • The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.
  • lnstructions to Applicant

    Please answer all questions. lf the answer to any question is "No" or "None", do not leave the item blank, but write "No" or "None".
  • *The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.
  • Current & Three Years Previous Addresses:

  • lf yes, give dates:
  • Education History

    Ptease circle the highest grade completed:
  • Employment History

    Give a Complete Record of all employment for the past three years, including any unemployment or self-employment, and all commercial driving experience for the past ten years.



  • *The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designed or used to transport nine or more passengers, g[ (3) is of any size, used to transport hazardous materials in a quantity requiring placarding.
  • Driving Experience

    Class of Equipment





  • Accident Record for past three years (attach sheet if more space is needed)



  • Traffic Convictions and Forfeitures for the last three years (other than parking violations)




  • Driver/s License (list each drive/s license held in the past three years)




  • Personal References

    List three persons for references, other than family members, who have knowledge of your safety habits.


  • To Be Read and Signed by Applicant

  • It is agreed and understood that any misrepresentation given on this application shall be considered on act of dishonesty.

    It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to ascertain any all information of concern to applicant's record, whether some is of record or not, and applicant releases employers ond persons named herein from all liability for any damages on account of his furnishings such information.

    It is also agreed and understood that under the Foir Credit Reporting Act, Public Low 97-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

    I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

    It is agreed and understood that this Application for Qualification in no way obligates the motor carrier to employ or hire the applicant.

    It is agreed and understood that if qualified and hired, I may be on o probationary period during which time I may be disqualified without recourse.

    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.