Truck Driver Application

DRIVER APPLICATION

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.
Position(s) Applied for
Full Name *

First Name Middle Name Last Name
List your addresses of residency for the past 3 years
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long?
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long?
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long?
Social Security Number *
Date of Birth *

Month Day Year
Can you provide proof of age?

Yes No
Phone Number *

Area Code Phone Number
E-mail (if you have one, list here)
If hired, can you furnish proof you are eligible to work in the U.S.? *

Yes No
Have you worked for this company before?

Yes No
Where?
Date From:

Month Day Year
Date To:

Month Day Year
Rate of Pay
Position
Reason for leaving?
Are you now employed?

Yes No
If you answered "no," how long since your last employment?
Who referred you to us?
Rate of Pay expected?
Have you ever been bonded?

Yes No
Name of bonding company?
Have you ever been convicted of a felony?

Yes No
If you answered "yes," please explain fully in this section. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered:
Is there any reason you might be unable to perform the functions of the job for which you have applied?

Yes No
If you answered "yes," explain here:
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. *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
Work History: Please list current, or most recent employment first. Then continue in descending chronological order.
Start date *

Month Day Year
Ending date *

Month Day Year
Employer Name *
Address
City, State *
Employer phone *

Area Code Phone Number
Position Held *
Reason for leaving *
Is this your current employer? *

Yes No
May we contact this employer at this time? *

Yes No
Contact Name: *
Contact Number: *
Was this a driving position? *

Yes No
Did you drive a vehicle requiring a CDL? *

Yes No
Salary/Wage: *
NEXT EMPLOYER
Start date *

Month Day Year
Ending date *

Month Day Year
Employer Name *
Address *
City, State *
Position Held *
Reason for leaving *
Was this a driving position? *

Yes No
Did you drive a vehicle requiring a CDL? *

Yes No
May we contact this employer? *

Yes No
Contact Name *
Contact Number *
Salary/Wage *
NEXT EMPLOYER
Starting date *

Month Day Year
Ending date *

Month Day Year
Employer Name *
Address *
City, State *
Position Held *
Reason for leaving *
Was this a driving position *

Yes No
Did you drive a vehicle requiring a CDL? *

Yes No
May we contact this employer? *

Yes No
Contact Name *
Contact Number *
Salary/Wage *
NEXT EMPLOYER
Employer Name *
Address *
City and State *
Position *
Reason for leaving *
Was this a driving position *

Yes No
Did you drive a vehicle requiring a CDL? *

Yes No
May we contact this employer? *

Yes No
Contact Name *
Contact Number *
Salary/Wage
If you need additional space for past employment, please enter it here and include ALL information previously asked for. *
Additional information including accidents, traffic violations and driver experience.
Do you have a CPNC license? *

Yes No
Have you had any moving violations in the last 5 years? *

Yes No
If yes, please list City, County and State, month, year and nature of offense and any fines involved
Please list miles over limit for speeding
Have you had any accidents in the last 5 years? *

Yes No
If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)

Experience and Qualifications - Driver *

State

License No.

Type

Expiration Date

Driver Licenses 1.

Driving Experience *

Type of Equipment (Van, Tank, Flat, ETC.)

Dates From

Dates To

Approximate No. of Miles (Total)

Straight Truck

Tractor and Semi-Trailer

Tractor - Two Trailers

Motorcoach - School Bus

Other

List states operated in for last five years *
Show special courses or training that will help you as a driver *
Which safe driving awards do you hold and from whom? *
Show any trucking, transportation, or other experience that may help you in your work for this company
List courses and training other than shown elsewhere in this application
List special equipment or technical materials you can work with (other than those already shown)
EDUCATION
List highest grade completed *
Last school attended *
Name and City *
Official Disclosure Statement:

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.

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 eployment 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 of the company.
Applicant's signature *
Date *

Month Day Year
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

List your addresses of residency for the past 3 years

EMPLOYMENT HISTORY

Additional information including accidents, traffic violations and driver experience.

EDUCATION