Commercial Driver Application

Step 1 of 12 - APPLICANT INFORMATION

Applicant Information

First Name(Required)

Middle Name

Last Name(Required)

Phone(Required)

Date of Application(Required)

Month

Day

Year

Date Available for Work(Required)

Month

Day

Year

Position Applied For(Required)

Referred By

Do you have the legal right to work in the United States?(Required)

Yes

Previous Three Years Residency

Current Address

Street Address(Required)

City(Required)

State(Required)

Number of Years at Address(Required)

Mailing Address

Street Address(Required)

City(Required)

State(Required)

Number of Years at Address(Required)

Previous Addresses

Street Address

City

State

Number of Years at Address

Street Address

City

State

Number of Years at Address

Street Address

City

State

Number of Years at Address

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below.(Required)

Certify

Include all licenses held for the past 3 years. You will have additional space at the end of the application to add more if needed.

Current License

State(Required)

License Number(Required)

Type/Class(Required)

Endorsements(Required)

Expiration Date(Required)

Previously Held Licenses

State

License Number

Type/Class

Endorsements

Expiration Date

State

License Number

Type/Class

Endorsements

Expiration Date

Driving Experience

Class - Straight Truck

Type of Equipment (Van, Tank, Flat, Etc)

Date From

Month

Day

Year

Date To

Month

Day

Year

Approx Number of Miles (Total)

Class - Tractor and Semi Trailer

Type of Equipment (Van, Tank, Flat, Etc)

Date From

Month

Day

Year

Date To

Month

Day

Year

Approx Number of Miles (Total)

Class - Tractor and Two Trailers

Type of Equipment (Van, Tank, Flat, Etc)

Date From

Month

Day

Year

Date To

Month

Day

Year

Approx Number of Miles (Total)

Class - Tractor and Tanker

Type of Equipment (Van, Tank, Flat, Etc)

Date From

Month

Day

Year

Date To

Month

Day

Year

Approx Number of Miles (Total)

Other

Type of Equipment (Van, Tank, Flat, Etc)

Date From

Month

Day

Year

Date To

Month

Day

Year

Approx Number of Miles (Total)

Accident Record for the Past Three Years

You will have additional space at the end of this application if more space is needed.

Check this box if you have no accident record(s) for the past three years.

No Accident Record(s)

Accident Information - List Most Recent First

Date

Month

Day

Year

Nature of Accident (head-on, rear-end, upset, etc)

Number of Fatalities

Number of Injuries

Chemical Spill?

Yes

Date

Month

Day

Year

Nature of Accident (head-on, rear-end, upset, etc)

Number of Fatalities

Number of Injuries

Chemical Spill?

Yes

Date

Month

Day

Year

Nature of Accident (head-on, rear-end, upset, etc)

Number of Fatalities

Number of Injuries

Chemical Spill?

Yes

Traffic convictions and forfeitures for the past three years (other than parking violations).

You will have additional space at the end of this application if more space is needed.

Check this box if you have no traffic convictions or forfeitures for the past three years.

No convictions or forfeitures

Date Convicted

Month

Day

Year

Nature of Violation

State the Violation Occurred In

Penalty (forfeited bond, collateral and/or points, etc)

Date Convicted

Month

Day

Year

Nature of Violation

State the Violation Occurred In

Penalty (forfeited bond, collateral and/or points, etc)

Date Convicted

Month

Day

Year

Nature of Violation

State the Violation Occurred In

Penalty (forfeited bond, collateral and/or points, etc)

Date Convicted

Month

Day

Year

Nature of Violation

State the Violation Occurred In

Penalty (forfeited bond, collateral and/or points, etc)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?(Required)

Yes

If yes, explain:

Has any license, permit, or privilege ever been suspended or revoked?(Required)

Yes

If yes, explain:

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment record in excess of one (1) month must be explained.

Start with the last or current position, including any military experience, and work backwards (you will have additional space at the end of this application if needed). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Current (Most Recent) Employer

Company Name

Company Phone Number

Street Address

City

State

Position Held

From Date (Month/Year)

To Date (Month/Year)

Reason for Leaving

Explain any gaps in employment (include month/year and reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?

Yes

Second (Most Recent) Employer

Company Name

Company Phone Number

Street Address

City

State

Position Held

From Date (Month/Year)

To Date (Month/Year)

Reason for Leaving

Explain any gaps in employment (include month/year and reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?

Yes

Third (Most Recent) Employer

Company Name

Company Phone Number

Street Address

City

State

Position Held

From Date (Month/Year)

To Date (Month/Year)

Reason for Leaving

Explain any gaps in employment (include month/year and reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?

Yes

References

Do you agree to have references contacted in relation to this application?(Required)

Yes

Professional Reference Name

Contact Number

Position Held / Working Relationship

Professional Reference Name

Contact Number

Position Held / Working Relationship

Education

High School

School Name

Location

Course of Study

Years Completed

Did You Graduate?

Yes

Additional Details If Applicable

College

School Name

Location

Course of Study

Years Completed

Did You Graduate?

Yes

Additional Details If Applicable

Other

School Name

Location

Course of Study

Years Completed

Did You Graduate?

Yes

Additional Details If Applicable

Additional Space and Qualifications

Extra Space for Residency, License Information, Driving Experience, Accident Records, Traffic Convictions and Forfeitures

Please list any other qualifications that you have and which you believe should be considered:

General Questions

Within the last three (3) years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?(Required)

Yes

If Yes, have you successfully completed the return-to-duty process?(Required)

Yes

Not Applicable

What type of work are you available for?(Required)

Full Time

Part Time

Have you applied to this company before?(Required)

Yes

Have you worked for Dan Cristiani Excavating before?(Required)

Yes

Are you a Prosser Alumni?(Required)

Yes

Are you currently employed?(Required)

Yes

Applicant Certification and Authorization

I certify that the information provided in this application and any accompanying materials is true and complete to the best of my knowledge. I understand that any inaccurate, misleading, or untrue statements, or the omission of relevant information, may result in the rejection of my application or termination of employment if discovered after employment begins.

I understand that this application does not constitute an offer of employment.

I authorize the Company to make investigations into my personal, employment, financial, medical, and other related history as may be necessary in arriving at an employment decision. I authorize the Company to contact my current and prior employers, schools, health care providers, and other relevant individuals or organizations for the purpose of verifying information provided in this application. I hereby release such parties from all liability in responding to inquiries and releasing information in connection with my application.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:
* Review information provided by current or previous employers
* Have errors in the information corrected by previous employers and have the corrected information resent to the prospective employer
* Submit a rebuttal statement regarding alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information

I understand that police, background, credit, or other employment-related checks may be required in certain circumstances, and I will be notified if such checks apply to my application.

If employed, I understand that I will be required to follow all rules, policies, and regulations of the Company.

Note: A motor carrier may require an applicant to provide additional information beyond that required by the Federal Motor Carrier Safety Regulations.

Do you understand and certify the above statement?(Required)

I understand and certify

Date of Certification(Required)

Month

Day

Year

Applicant Name(Required)