Application for Driver | The HR & Logistics Professionals!

1Position Applied For

Position / Job Title ★

Date of Application ★

Employment Desired

Full-Time Part-Time Seasonal

Date Available to Start

Desired Salary / Rate

How did you hear about us?

2Personal Information

Last Name ★

First Name ★

Middle Name / Initial

Street Address ★

Apt / Suite

City ★

State ★

ZIP Code ★

Phone (Primary) ★

Phone (Alternate)

Email Address ★

Social Security Number ★ Required for DOT background & employment verification.

Date of Birth ★

Are you at least 21 years old? (DOT requirement)

Yes No

Are you legally authorized to work in the U.S.?

Yes No

Have you ever worked under a different name?

Yes No

If yes, previous name(s)

3Driver's License & CDL Information (DOT 391.21)

DOT Requirement: List all licenses held in the past 3 years. Failure to disclose is grounds for disqualification.

License Number ★

Issuing State ★

License Class ★

Expiration Date ★

CDL Endorsements

Restrictions (if any)

Have you held any other licenses in the past 3 years?

License #

State

Expiration

Has your license ever been suspended or revoked?

Yes No

If yes, explain

4Driving Experience (DOT 391.21(b)(8))

List all types of equipment operated. Check all that apply and indicate years of experience.

Equipment Type(s) Operated

Tractor-Trailer (18-Wheeler) Straight Truck Tanker Flatbed Reefer/Refrigerated Hazmat Double/Triple Trailers Bus/Coach Other

Total Commercial Driving Experience

Approximate Miles Driven (Total Career)

Types of Hauls / Freight

Do you have experience with Electronic Logging Devices (ELD)?

Yes No

5Accident & Traffic Violation History (DOT 391.21(b)(9–10))

Federal law requires disclosure of all accidents and violations in the past 3 years. Omissions may result in disqualification and are a federal violation.

Accidents in the past 3 years

Number of preventable accidents

Number of non-preventable accidents

Accident details (date, location, injuries, fatalities, HazMat spills)

Traffic convictions & forfeitures in the past 3 years (excluding parking)

Violation details (date, location, charge, penalty)

Have you ever been convicted of a DUI / DWI / OUI?

Yes No

6Employment History – Past 10 Years (DOT 391.21(b)(6–7))

DOT requires a complete 10-year employment history. List all employers starting with most recent. Account for all gaps.

Employer 1 (Most Recent)

Company Name ★

Job Title / Position

Address / City, State

Phone

Start Date

End Date

Reason for Leaving

Were you subject to the FMCSRs?

Yes No

Was job designated as safety-sensitive under DOT?

Yes No

Employer 2

Company Name

Job Title

Address / City, State

Phone

Start Date

End Date

Reason for Leaving

Were you subject to the FMCSRs?

Yes No

Safety-sensitive position?

Yes No

Employer 3

Company Name

Job Title

Address / City, State

Phone

Start Date

End Date

Reason for Leaving

Were you subject to FMCSRs or safety-sensitive under DOT?

Yes No

Explain any gaps in employment

7DOT Drug & Alcohol Testing History (49 CFR 382.413)

Federal law requires disclosure of prior drug/alcohol test results. Applies to all safety-sensitive DOT-regulated positions held in the past 3 years.

Have you tested positive or refused a DOT drug/alcohol test in the past 3 years?

Yes No

If yes, explain (employer, date, substance, SAP completion)

Have you successfully completed a Substance Abuse Professional (SAP) program?

Yes No N/A

Do you consent to pre-employment, random, and post-accident DOT drug & alcohol testing?

Yes No

8Background, Medical & Additional DOT Disclosures

Do you have a valid DOT Medical Certificate?

Yes No

Medical Certificate Expiration Date

Have you ever been denied a DOT medical certificate?

Yes No

Are you currently taking prescription medication that may affect driving?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, explain (state law may limit relevance)

Do you authorize us to contact previous employers and obtain driving records?

Yes No

9Certification & Applicant Signature

Applicant Certification

I certify that all information provided in this application is true, correct, and complete. I understand that falsification, misrepresentation, or omission of any facts may result in disqualification from employment or termination if discovered after hire. I authorize investigation of all statements, references, and driving records contained in this application. I understand this application is subject to DOT regulations under 49 CFR Part 391 and consent to all pre-employment and ongoing DOT requirements including drug and alcohol testing.

Full Legal Name (Printed) ★

Electronic Signature (Type Full Name) ★

Date Signed ★

Applicant Email (confirmation copy)

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Applicant Certification

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