* indicates required field
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Driver Information
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CDL Info.
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Driving Experience
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Work History
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Criminal History
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Have you ever had a Felony Conviction?
Yes | No If so, when? (mm-dd-yyy)
Do you have Pending DUI Charges?
Yes | No If so, when? (mm-dd-yyy)
Do you have any Drug Convictions?
Yes | No If so, when? (mm-dd-yyy)
Have you ever been denied a license or permit for operating a motor vehicle?
Yes | No If so, when? (mm-dd-yyy)
Has your license or permit ever been suspended/revoked?
Yes | No If so, when? (mm-dd-yyy)
Have you been convicted, or are there charges pending, for reckless driving or careless operation?
Yes | No If so, when? (mm-dd-yyy)
Have you ever been refused any type of insurance or been denied bonding?
Yes | No If so, when? (mm-dd-yyy)
Have you ever been discharged or suspended while working for another employer?
Yes | No If so, when? (mm-dd-yyy) |
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Comments
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Disclaimer:
I certify that I personally completed this application and that all the
information is true and correct to the absolute best of my knowledge.
I request and authorize companies and representatives of carrier
companies to investigate my background for employment purposes. Potential
employers that receive this application are authorized to investigate any
alcohol or drug tests, criminal history, MVR and DAC reports, and character
history.
I acknowledge that the DOT requires carrier companies and their agents to
investigate my employment background which may include, but is not limited
to, DAC Services. DAC Services is a consumer-reporting agency that does
not make decisions concerning your employment. Your consent for carrier
companies to obtain DAC reports is required and carrier companies alone
decide your employment status.
I have read this Disclaimer and consumer reports may be obtained about me from DAC Services.
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Thank you.
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