Please give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self employment periods, and all commercial driving experience (owner/operator/investor) for the past ten (10) years.
List three (3) references, other than family members, who have knowledge of your safety habits.
Notice to Applicants
By signing below you acknowledge the following: It is agreed and understood that any misrepresentation given on
this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his
agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s
record, whether same is of record or not, and applicant releases employers and person named herein from all
liability for any damages on account of his furnishing such information. It is also agreed and understood that
under the Fair Credit Reporting Act, Public Law 91-508,
I have been told that this investigation may include an investigating Consumer Report, including information
regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such
additional information and complete such examinations as may be required to complete my application file. It is
agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant.
It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may
be disqualified without recourse. 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.
For Office Use Only