• Bluffton: 260-824-2220
  • Fort Wayne: 800-322-8454

Employment Application

Employment Application Form

Employment Application For CDL/Transport Drivers


License Information

Section 383.21 FMCSR states: "No person who operates a commercial motor vehicle shall, at any one time, have more than one drivers license."

Driving Experience

Class Of Equipment Equipment Type Dates Approx No. Miles Driven
Straight Truck
Tractor & Semi-Trailer
Tractor Two Trailers

Accident Record For Past 3 Years Or More

Date Of Accident Nature Of Accident Number Of Fatalities Number Of Injuries Chemical Spill

Traffic Convictions Or Forfeitures Over The Past 3 Years (Other than parking violations)

Date Convicted State Of Violation Violation Penalty
(Forfeited bond, collateral, points, etc.)

Employment Record

Applicants that desire to drive in interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial years (total of ten years employment record)

Must list the complete mailing address: street number and name, city, state and zip code.

To Be Read And Signed By Applicant

I authorize you to make sure investigations and inquires to my personal, employment, financial or medical history and other related matters as may be necessary in arriving as an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment is has been extended.) I herby release employers, schools, health care providers and other persons from liability in responding to inquires 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 t abide by all rules adn regulations of the Company.

"I understand the information I provide regarding my current and/or previous 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(d) and (e). I understand that O have the right to:

  • Review information provided by current/previous employers
  • Have errors in the information corrected by previous employers and those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information."

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.

Note: A motor carrier mya require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.