Application for Employment – Commercial Driver

H5 Application for Employment – Commercial Driver

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Are you currently employed?*

Yes

If not, how long since leaving last employment?

Highest grade completed*

High School

College

Graduate School

Other

Have you served in the U.S. Armed Forces?*

Yes

Other

If yes, which branch of service?

Are you currently serving in the Military Reserves or Guards?

Yes

Have you ever been convicted of a felony?*

If yes, please briefly explain below. Conviction of a crime is not an automatic bar to employment – all circumstances will be considered.

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Date of Birth*

The Federal Motor Carrier Safety Regulations (49CFR391.21) (b) (2) requires that driver applicants state their date of birth and Social Security number. Please enter DOB below.

Social Security Number*

The Federal Motor Carrier Safety Regulations (49CFR391.21) (b) (2) requires that driver applicants state their date of birth and Social Security number. Please enter SSN below.

DOT Medical Card Expiration*

The Federal Motor Carrier Safety Regulations requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle. Please enter the expiration date of your DOT Medical Card below.

Alcohol & Controlled Substance Statement No. 1*

Within the last two 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?

Yes

Alcohol & Controlled Substance Statement No. 2*

Within the last two years, have you ever tested positive, or refused to test on any type of drug or alcohol test administered by an employer for which you performed safety-sensitive transportation work?

Yes

Alcohol & Controlled Substance Statement No. 3*

If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes

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Driver's License Information*

Please use the (+) symbol to add additional licenses.

State

License Number

Type

Exp Date

Driver's License Information No. 1*

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

Yes

Driver's License Information No. 2*

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

Yes

Driver's License Information No. 3*

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

Yes

Driving Experience*

Please use the (+) symbol to add additional equipment experience.

Type of Equipment (Van, Tank, Flat, etc.)

Dates From – To

Approximate Total Miles

List states operated in during the last five years:*

List special courses or training that will help you as a driver:

List safe driving awards held and who awards were presented by:

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Accident History*

Please describe any accidents for the past 3 years below. Include date, the nature of the accident (rear-end, etc), fatalities if any, injuries if any, and if a citation was issued.

Motor Vehicle Driving Record (MVR)*

Please describe any traffic convictions for the past 3 years below. Include date, location, the charge, and penalty.

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Employment Record No. 1*

Please include employer name, address, phone, dates from-to, and reason for leaving.

Employment Record No. 2*

Please include employer name, address, phone, dates from-to, and reason for leaving.

Employment Record No. 3*

Please include employer name, address, phone, dates from-to, and reason for leaving.

Resume Upload (if applicable)

Drop files here or

Max. file size: 100 MB, Max. files: 3.

If you have one, please upload your resume here.

H5 Transport, LLC

Application for Employment – Commercial Driver

H5 Application for Employment – Commercial Driver

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