Employment Application

The information requested on this form is required by federal law (49 CFR) to be provided by any driver applying for a commercial driver position as defined in 49 CFR 390.5. lnfom1ation provided will be verified as required under various parts of 49 CFR, including Part 382 and part 391. If you require help completing this application, please ask an employer representative.

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 or non-job related disability.

Previous Addresses:

If less than 3 years.


(Commonwealth of PA Drivers License#/ permission to check your Motor Vehicle Report. Employment is subject to favorable MVR)

Employment History
Accident Record

Provide the following information for any accident you were involved in during the preceding 3 years in order from most recent to oldest.

Traffic Convictions

Provide the following information for all motor vechicle violations for which you were convicted or pled guily to during the preceding 3 years in order from most recent to oldest.(Do not include parking tickets)

Experience and Qualifications - Driver

List all driver licenses or permits held in the past 3 years in order from most recent to oldest.

Driving Experience
Drug and Alcohol Information

In the previous three (3) years, have you:

Check All The Apply

This certifies that I completed this application, 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 employment decision. (Generally, inquires 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.