Driver Application Form Page 2
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3Employment History
All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceding
three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior
to the initial three years (total of ten year employment record).
You are required to list the complete mailing address; street number and name, city, state, and zip code.
CURRENT OR LAST EMPLOYER: Name _____________________________________Phone Number (_____) ________________
Street Address___________________________________ City_______________________ State ________ Zip _________________
Position Held____________________________________ From______________________ To_______________________________
(Month / Year)
(Month / Year)
Reasons for Leaving___________________________________________________________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations** while employed? _____Yes _____No
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements
of 49 CFR Part 40? _____Yes _____No
*ACCOUNT FOR PERIOD BETWEEN JOBS – Include dates (month/year) and reason_____________________________________
PREVIOUS EMPLOYER: Name ___________________________________________Phone Number (_____) __________________
Street Address___________________________________ City_______________________ State ________ Zip _________________
Position Held____________________________________ From______________________ To_______________________________
(Month / Year)
(Month / Year)
Reasons for Leaving___________________________________________________________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations** while employed? _____Yes _____No
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements
of 49 CFR Part 40? _____Yes _____No
*ACCOUNT FOR PERIOD BETWEEN JOBS – Include dates (month/year) and reason_____________________________________
PREVIOUS EMPLOYER: Name ___________________________________________Phone Number (_____) __________________
Street Address___________________________________ City_______________________ State ________ Zip _________________
Position Held____________________________________ From______________________ To_______________________________
(Month / Year)
(Month / Year)
Reasons for Leaving___________________________________________________________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations** while employed? _____Yes _____No
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements
of 49 CFR Part 40? _____Yes _____No
*ACCOUNT FOR PERIOD BETWEEN JOBS – Include dates (month/year) and reason_____________________________________
PREVIOUS EMPLOYER: Name ___________________________________________Phone Number (_____) __________________
Street Address___________________________________ City_______________________ State ________ Zip _________________
Position Held____________________________________ From______________________ To_______________________________
(Month / Year)
(Month / Year)
Reasons for Leaving___________________________________________________________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations** while employed? _____Yes _____No
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements
of 49 CFR Part 40? _____Yes _____No
*ACCOUNT FOR PERIOD BETWEEN JOBS – Include dates (month/year) and reason_____________________________________
*Any gaps in employment and/or unemployment must be explained. **The Federal Motor Carrier Safety Regulations 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 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
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