Driver’s Application for Employment Download Driver’s Application 1Employee Information2Employment History3Accident Record and Education Applicant Name* First Last Date* MM slash DD slash YYYY Company Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.TO BE READ AND SIGNED BY APPLICANT*I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to: • Review information provided by previous employers; • Have errors in the information corrected by previous employers and for those previous employers to re-send 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. I have read and understand the following:Signature* APPLICANT TO COMPLETEPosition(s) Applied for Name First Middle Last Social Security Number List your addresses of residency for the past 3 years.Current Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneHow Long?yr./mo. Previous AddressAdd as many addresses as necessaryStreetCityState & Zip CodeHow Long? (yr./mo.) Do you have the legal right to work in the United States? Yes No Date of Birth(required for Commercial Drivers) Month Day Year Can you provide proof of age? Yes No Have you worked for this company before? Yes No Where? Start Date Month Day Year End Date Month Day Year Rate of Pay Position Reason for leaving? Who referred you? Rate of pay expected Have you ever been bonded?(Answer only if a job requirement) Yes No Name of bonding company Can you perform, with or without reasonable accommodation, the essential functions of the job [as described in the attached job description]? Yes No Employment HistoryAll driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add as many as necessary)EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving EmployerName Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person PhoneWere you subject o the FMCSRs† 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 Start Date Month Day Year End Date Month Day Year Position Held Reason for Leaving *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding. †The Federal Motor Carrier Safety Regulations (FMCSRs) 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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding. ACCIDENT RECORDFor past 3 years or more. If none, write none. DatesNature of Accident (Head-on, Rear-End, Upset, Etc.)FatalitiesInjuriesHazardous Material Spill TRAFFIC CONVICTIONSAnd forfeitures for the past 3 years (other than parking violations). If none, write none.LocationDateChargePenalty EXPERIENCE AND QUALIFICATIONS - DRIVERDriver licenses or permits held in the past 3 years.StateLicense No.ClassEndorsement(s)Expiration Date A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Has any license, permit or privilege ever been suspended or revoked? Yes No If the answer to either A or B is yes, please give the details.Driving Experience (Check yes or no)Straight Truck Yes No (Van, Tank, Flat, Dump, Refer) - Enter oneFrom Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)Tractor and Semi-Trailer Yes No (Van, Tank, Flat, Dump, Refer) - Enter oneFrom Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)Tractor - Two Trailers Yes No (Van, Tank, Flat, Dump, Refer) - Enter oneFrom Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)Tractor - Three Trailers Yes No (Van, Tank, Flat, Dump, Refer) - Enter oneFrom Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)Motorcoach - School BusMore than 8 passengers Yes No From Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)Motorcoach - School Bus (15)More than 15 passengers Yes No From Date (M/Y)To Date (M/Y)Approx. No. of Miles (Total)OtherList States Operated in for the Last Five Years Show Special Courses or Training that will Help You as a DriverWhich Safe Driving Awards Do you Hold and From Whom?Experience and Qualifications - Other Show any Trucking, Transportation or other Experience that May Help in your Work for this CompanyList Courses and Training other than Show Elsewhere in this ApplicationList Special Equipment or Technical Materials you can Work With (other than those already shown)EDUCATION Select Highest Grade Completed12345678High School1234College1234Last School AttendedNameCityStateTO BE READ AND SIGNED BY APPLICANT 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. Enter Name* First Last Signature*Date* MM slash DD slash YYYY CAPTCHA Want More Information? Get a Quote © 2021 Gateway Advantage | All Rights Reserved | Privacy Policy