Commercial Truck Driving Application "*" indicates required fields Step 1 of 5 - Applicant Information 20% Applicant Name * Required First Last Address * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you lived at an additional address in the past three years? * RequiredNoYesIf yes, please list all previous addresses in the past three years.Email * Required Phone * Required Active Commercial Motor Vehicle Licenses or PermitsPlease list all active licenses, including Issuing State, License Number and Expiration Date * RequiredHave you ever had any driver license denied, suspended, revoked or cancelled by any issuing state agency? * RequiredNoYesIf yes, state of issuance and explanation: * Required ExperienceExperience Type of Motor Vehicle Type of Trailer Date Range [From-To] Approximate Miles Actions Edit Delete There are no Entries. Add Experience Maximum number of entries reached. Motor Vehicle AccidentsHave you been in any motor vehicle accidents during the last 3 years? * RequiredNoYesMotor Vehicle AccidentsList motor vehicle accidents from the past 3 years. Date of Accident Description Actions Edit Delete There are no Accidents . Add Accident Maximum number of accidents reached. Traffic Violation ConvictionsHave you been convicted of any traffic violations during the last 3 years? * RequiredNoYesTraffic ViolationsList traffic violations from the past 3 years. Date of Violation Violation Actions Edit Delete There are no Violations. Add Violation Maximum number of violations reached. Previous EmploymentList employers from the past 10 years and account for gaps between. Employer Name Employer Phone Supervisor Name Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. Please explain any gaps between positions Consent * Required “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.”For driver applicants of commercial motor vehicles that require a Commercial Driver License (CDL) the applicant must disclose their controlled substance and alcohol status per the requirements of 49 CFR part 40.25(j). As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re-send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at any time, including when applying or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records. Applicant Name * Required First Last Today's Date * Required MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.