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Driver's Application for Employment

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal. employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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 understand, also, that I am required to abide by all rules and regulations ot the Company. I understand that information I provide regarding current and/or previous employ~rs 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.

APPLICANT TO COMPLETE

XXX-XX-XXXX

List your addresses of residency for the past 3 years.

(Required for Commercial Drivers)
Write N/A if you weren't referred.
(Answer only if a job requirement)

EMPLOYMENT HISTORY


All 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 another sheet as necessary.)

*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.


**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.

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