Driver Application | CND Trucking

Authorization Notice: 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. 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.

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).

Personal Information

Last Name

First Name

Middle Name

Social Security Number

Phone Number

Date of Birth

Email Address

A confirmation email will be sent to this address.

Current Address

Street Address

City

State

ZIP Code

Years at Address

Previous Addresses (Past 3 Years)

List all addresses for the past 3 years if you've lived at your current address less than 3 years.

Previous Address 1

Street Address

City

State

ZIP Code

Years at Address

Previous Address 2

Street Address

City

State

ZIP Code

Years at Address

Employment History

Required by Federal Law (49 CFR 391.21): All applicants must provide employment information for the preceding 3 years. Applicants wishing to drive in interstate commerce must also provide information for all commercial driving positions for 7 years prior (total 10 years). All gaps in employment must be explained.

Current or Most Recent Employer

Employer Name

Phone Number

Street Address

City

State

ZIP Code

Position Held

From (MM/YYYY)

To (MM/YYYY)

Reason for Leaving

Were you subject to Federal Motor Carrier Safety Regulations?

Yes No

Was this a DOT safety-sensitive position subject to drug/alcohol testing (49 CFR Part 40)?

Yes No

Second Most Recent Employer

Employer Name

Phone Number

Street Address

City

State

ZIP Code

Position Held

From (MM/YYYY)

To (MM/YYYY)

Reason for Leaving

Were you subject to Federal Motor Carrier Safety Regulations?

Yes No

Was this a DOT safety-sensitive position subject to drug/alcohol testing (49 CFR Part 40)?

Yes No

Account for any gap between this job and the previous one:

Third Most Recent Employer

Employer Name

Phone Number

Street Address

City

State

ZIP Code

Position Held

From (MM/YYYY)

To (MM/YYYY)

Reason for Leaving

Were you subject to Federal Motor Carrier Safety Regulations?

Yes No

Was this a DOT safety-sensitive position subject to drug/alcohol testing (49 CFR Part 40)?

Yes No

Account for any gap between this job and the previous one:

Additional Work History

If you have had more than 3 jobs in the last 10 years, list them here including employer name, address, position, dates, and reason for leaving.

Additional Employment History

Driving Experience

Select all vehicle types you have experience operating:

Straight Truck Tractor & Semi-Trailer Tractor - Two Trailers (Doubles) Tractor - Three Trailers (Triples) Tanker Hazardous Materials Flatbed Refrigerated (Reefer) Motorcoach / Bus

Other Experience

Accident History (Past 3 Years)

No accidents within the last 3 years

Accident 1

Date

Nature of Accident

Fatalities

Injuries

Hazardous Materials Spill?

Yes No

Accident 2

Date

Nature of Accident

Fatalities

Injuries

Hazardous Materials Spill?

Yes No

Accident 3

Date

Nature of Accident

Fatalities

Injuries

Hazardous Materials Spill?

Yes No

Traffic Convictions and Forfeitures (Past 3 Years)

Do not include parking violations.

No traffic convictions or forfeitures in the last 3 years

Conviction 1

Date

Violation

State

Penalty

Conviction 2

Date

Violation

State

Penalty

Conviction 3

Date

Violation

State

Penalty

License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license."

State

License Number

Issue Date

Expiration Date

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

Yes No

If yes, provide details:

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

Yes No

If yes, provide details:

Emergency Contact

Contact Name

Relationship

Phone Number

Applicant Certification

Certification: 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. I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that I am required to abide by all rules and regulations of the Company.

I certify that I do not have more than one motor vehicle license.

I understand that I have the right to: review information provided by current/previous employers; have errors corrected by previous employers; and have a rebuttal statement attached to alleged erroneous information.

I consent to a background check. I authorize CND Trucking to obtain information about my employment history, driving record, criminal history, and other relevant background information for employment purposes.

Applicant Signature

Date

CND Trucking Commercial Driver Application

Instructions

Personal Information

Current Address

Previous Addresses (Past 3 Years)

Previous Address 1

Previous Address 2

Employment History

Current or Most Recent Employer

Second Most Recent Employer

Third Most Recent Employer

Additional Work History

Driving Experience

Accident History (Past 3 Years)

Accident 1

Accident 2

Accident 3

Traffic Convictions and Forfeitures (Past 3 Years)

Conviction 1

Conviction 2

Conviction 3

License Information

Emergency Contact

Applicant Certification