Fields marked with an * are required

Driver Employment Application


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, inquiries 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.

I understand that information I provide regarding 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 I have the right to:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for 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.
List your addresses of residency for the past 3 years.
Previous Experience

List last employment first.  Include summer or temporary jobs.  Be sure all your experience or employers related to this job are listed in the following sections.

Driving History
Driver Experience

Driver Licenses or permits held in the past 3 years.  Notify interviewer if more room is required.

Driving Experience

Select yes or no.

Experience Continued
Emergency Contact
Information to the applicant: 

As part of our procedure for processing your employment application, your personal and employment references may be checked.  If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.  You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the U.S., have a physical examination and/or drug test, or to sign a conflict of interest agreement and abide by its terms.


To be Read and Initialed by Applicant

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.

Equal Employment Opportunity:

While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race, and sex for planning and reporting purposes only.  This information is optional and failure to provide it will have no affect on your application for employment.