CDL Employee Application Please complete the fields in the form below and submit to apply online. Name* First Last Email* Phone*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 License InformationDriver's License Number*State Issued* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State CDL Held Since?*Expiration Date*Class A, B, C*EndorsementsDriving HistoryDriving Experience*Equipment Class (ex., Straight Truck, Tractor Semitrailer, Tractor with Doubles, Tractor with Triples, Tractor with Tank, etc.) Equipment Type (ex., van, flat, tank). Please add all that applies by clicking on the + for additional rows.Equipment ClassEquipment TypeFromTo Past 3 Years Accidents/CrashesNature of Accident (ex., backing, head-on, rollover, turning). Please add all that applies by clicking on the + for additional rows.DateNature of AccidentFatalitiesInjuries Past 3 Years Moving Traffic Convictions & ForfeituresPlease add all that applies by clicking on the + for additional rows.Date of ConvictionOffenseLocationType of Vehicle Operated Have you ever been denied a license, permit, or priveledge to operate a motor vehicle?* Yes No Please provide details why you were denied.*Has any license, permit or privilege ever been revoked?* Yes No Please provide details it was revoked.*Controlled Substances TestingThis company requires all drivers who drive commercial motor vehicles (CMVs) that require a commercial driver’s license (CDL) to be controlled substances tested with a negative result prior to driving. The prospective employee is required by Sec. 40.25(j) to respond to the following questions.Do you consent to controlled substances testing?* Yes No Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years?* Yes No Can you provide/obtain proof that you’ve successfully completed the DOT return-to-duty requirements?* Yes No Employment HistoryThe Federal Motor Carrier Regulations (49 CFR § 391.21) require that all applicants wishing to drive a CMV list all employment for the last three years. In addition, if you have driven a CMV previously, you must provide employment history for an additional seven years (for a total of 10 years). Any gaps in employment in excess of one month must be explained.Last EmployersPlease add all that applies by clicking on the + for additional rows.EmployerPosition HeldFromToPhone No. Were you subject to the Federal Motor Carrier Safety Regulations at any of these employers? Yes No Which employer(s)?Was your job designated as a safety-sensitive function in any DOT-regulated mode and subject to alcohol and controlled substance testing at any of the above previous employers? Yes No Which employer(s)?Upload FilesPlease make a copy of your driver's license and medical certificate and upload here. Drop files here or Accepted file types: jpg, png, pdf. Fair Credit Reporting Act Disclosure StatementIn accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Pulblic Law 91-508, as amended by the Consumer Credit Reporting Act of 1996(Title II, Subtitle D, Chapter 1, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations.Consent* By checking this box and submitting this application, I certify that all information provided is true, complete, and correct to the best of my knowledge. I understand that any misrepresentation, falsification, or deliberate omission of information may result in the rejection of my application or immediate termination of employment. This also certifies that I have read and understood all information given to me in this application.CommentsThis field is for validation purposes and should be left unchanged. Δ
