Application Submission

Applicant Information
Yes
No
Previous Three Years Residency
License Information
Driving Experience
Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Date From Date To Approx # of Miles (Total)
Straight Truck
Semi Truck
Semi Trailer
Tractor & Semi-Trailer
Tractor & 2 Trailers
Tractor & Tanker
Other
Accident Record for the Past 3 Years
Dates (most recent first) Nature of Accident # Fatalities # Injuries Chemical Spills (Y/N)
Traffic Convictions and Forfeitures for the Past 3 Years (Other Than Parking Violations)
Date Convicted (Month/Year) Violation State of Violation Penalty
Yes
No
Yes
No

Employment History

Please list your previous employers, starting with the most recent.

Education
SCHOOL NAME & LOCATION COURSE OF STUDY YEARS COMPLETED GRADUATE DETAILS
High School
College
Other
Other Qualifications
Document Uploads
You may upload multiple documents.
Applicant Authorization & Certification

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:

  • Review information provided by current/previous employers;
  • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.