Commercial Driver Application printable pdf download

COMMERCIAL DRIVER APPLICATION

Company______________________________________________________________________

Address_______________________________________________________________________

City__________________________________________State_____________Zip_____________

APPLICANT INFORMATION

DATE________________ Position applying for:

Contractor

Driver

Contractor’s Driver

NAME_________________________________________________________________________

PHONE (

)____________________ EMERGENCY PHONE (

)___________________

AGE_____________ DATE OF BIRTH_____________________SS#_____________________

(The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40

but less than 70 years of age.)

PHYSICAL EXAM EXPIRATION DATE_____________________

CURRENT & PREVIOUS THREE YEARS ADDRESSES:

___________________________________________________FROM________________TO____________________

HAVE YOU WORKED FOR THIS COMPANY BEFORE? _______Yes

________No

If yes, give dates: From_______________ To_________________

Reason for leaving? _______________________________________________________________________________

EDUCATION HISTORY:

Please circle the highest grade completed:

Grade school: 1 2 3 4 5 6 7 8 9 10 11 12

College: 1 2 3 4

Post Graduate: 1 2 3 4

EMPLOYMENT HISTORY:

Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self

employment periods, and all commercial driving experience for the past ten (10) years.

Mo/Yr

Present or Last Employer

From____________To___________ Name_____________________________________________________________

Position Held_____________________Address_________________________________________________________

Reason for leaving___________________________________________Company phone (

)__________________

Were you subject to the FMCSRs while employed here? ____________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