Driver Application Form - Fresh Tracks Transportation

Driver’s Application for Employment

Driver Signup Form

Applicant information

First Name

Middle Name

Last Name

Address

Street Address

Address Line 2

City

State / Province / Region

Date of Birth

Social Security Number

Cell Phone

Previous addresses:(If at the above address for less than three years)

Address

Street Address

Address Line 2

City

State / Province / Region

How Long?

Address

Street Address

Address Line 2

City

State / Province / Region

How Long?

Experience and Qualifications-Driver

Driver Licenses

State

License No.

Type and endorsements

Expiration Date

Driving Experience

Class of Equipment:

Straight truck

Type of equipment (Van, Tank, Flatbed, etc.)

From Date

To Date

Approximate # of Miles (total)

Accident record for past three years (attach additional sheet if necessary)

Dates Last accident

Next previous

Accident record for past three years (attach additional sheet if necessary)

Location

Date

Charge

Penalty

Have you ever been convicted of a felony

Yes

If yes, please give date, place, offense, and outcome

Driving History

A. At what age were you issued your first Driver’s License?

B. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

C. Has any license, permit or privilege ever been suspended, revoked or denied?

Yes

If the answer to either B or C is yes, explain: (attach additional sheet if necessary)

D. Is there any reason; medical or other that would prevent you from operating a motor vehicle in accordance with all state and federal transportation regulations?

Yes

If YES, please explain:

Employment Record (attach additional sheet(s) if more space is needed)

You are required to give all employment information for at least three years.

Last employer:

First Name

Last Name

Address

Street Address

Address Line 2

City

State / Province / Region

Supervisor First Name

Supervisor Last Name

Contact Number

Position Held

Dates

From

Salary

Reasons for leaving

Was this employer subject to Federal (or PUC) Motor Carrier Safety Regulations?

Yes

Were you subject to controlled substance & alcohol testing under 49 CFR Parts 40/382 while employed here

Yes

To be read and signed by applicant:

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

Date

(Applicant’s signature)

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