APPLICATION FOR CDL CLASS A DRIVER Today's date * MM DD YYYY Name * First Name Last Name Phone * (###) ### #### Social Security Number * Address * Include address, city, state and zip code Date of Birth * MM DD YYYY Address(es) for past 3 years * EXPERIENCE & QUALIFICATIONS Driver's Licenses * Please include state, license number, type and expiration. Have you ever been denied a license, permit or privilege to operate a vehicle? * YES NO HAS ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? * YES NO If you answered "yes" to the two questions above please provide more details. DRIVING EXPERIENCE Outline any experience with straight trucks. Include type of equipment, time period you operated equipment and the approximate mileage you accrued. Outline any experience with a tractor and semi-trailer. Include type of equipment, time period you operated equipment and the approximate mileage you accrued. Outline any experience with a tractor and two trailers. Include type of equipment, time period you operated equipment and the approximate mileage you accrued. Share other relevant driving experience here. ACCIDENT RECORD If applicable, outline accidents for past 3 years or more. Include date, nature of accident, and note any fatalities and injuries. TRAFFIC RECORD If applicable, outline traffic convictions for past 3 years or more. Include location, date, charge and penalty. EMPLOYMENT HISTORY Most recent employer * Address * Include address, city, state and zip code Position held * Start date MM DD YYYY Leave date MM DD YYYY Pay rate Reason for leaving Subject to FMCSRs? YES NO Subject to drug/alcohol testing requirements per 49 CFR Part 40? * YES NO Second most recent employer Address Include address, city, state and zip code Position held Start date MM DD YYYY Leave date MM DD YYYY Pay rate Reason for leaving Subject to FMCSRs? YES NO Subject to drug/alcohol testing requirements per 49 CFR Part 40? YES NO Third most recent employer * Address Include address, city, state and zip code Position held Start date MM DD YYYY Leave date MM DD YYYY Pay rate Reason for leaving Subject to FMCSRs? YES NO Subject to drug/alcohol testing requirements per 49 CFR Part 40? YES NO Fourth most recent employer Address Include address, city, state and zip code Position held Start date MM DD YYYY Leave date MM DD YYYY Pay rate Reason for leaving Subject to FMCSRs? YES NO Subject to drug/alcohol testing requirements per 49 CFR Part 40? YES NO As a prospective employer, we must ask any applicant for a driving position with our company whether he/she has tested positive or refused to test on any pre-employment drug or alcohol test administered by an employer to which the applied for but did not obtain "safety-sensitive transportation work" (driving a commercial motor vehicle.) DOT regulations prohibit our utilizing you to perform a "safety-sensitive function if you had a positive test or refusal to test until and unless you provide documents showing successful completion of the return-to-duty process in accordance with DOT regulations. * YES, I have tested positive for drugs/alcohol or refused to take a pre-employment drug/alcohol test in the two years preceding the date of this application. NO, I have NOT tested positive for drugs/alcohol or refused to take a pre-employment drug/alcohol test in the two years preceding the date of this application. Thank you!