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Employment Application: Driver

PLEASE FILL OUT ALL INFORMATION ON FORM

CMV Driver's Employment Application
Name
Name
First
Last
Current Address
Current Address
City
State/Province
Zip/Postal
Previous Address
Previous Address
City
State/Province
Zip/Postal
Are you legally authorized to work in the United States as a commercial driver under 49 CFR?
Have you ever been convicted of a felony?
Are you applying for ADA consideration?

Employment History

All applicants must provide the following information for any previous employer during the preceding 3 years. Complete all areas below. Applicants shall also provide an additional 7 years of information for those employers for whom the applicant has operated a commercial motor vehicle (CMV). List all employers in reverse order starting with the most recent.
Address
Address
City
State/Province
Zip/Postal
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?

Experience and Qualifications - Driver

List all driver licenses or permits held in the past 3 years.
Has any license, permit or privilege ever been suspended or revoked?
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Maximum upload size: 8.39MB
Please upload a PDF copy.

Driving Experience

Select the appropriate class of equipment from the first menu, then add more for each that apply.
Approximate Number (Total)

Drug and Alcohol Information

Please answer all questions for up to three (3) years.
Have you violated the Alcohol and Control Substance prohibitions under subpart B of 49CFR Part 382 or 49CFR Part 40?
Have you failed to undertake or complete a rehabilitation program prescribed by a SAP pursuant to 49CFR 282.605?
I certify that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.