Application for Employment - Driver of Commercial Vehicle

Legal Name
Previous Address(es) of last 3 years
Motor Vehicle License State and Number
Expiration Date
Driving Experience includes what types of vehicles?
Please list all motor vehicle accidents involved in the past 3 years including date, nature of accident, personal injuries or fatalities:
List all violations of motor vehicle laws or ordinances (other than parking violations) convicted of or forfeited bond/collateral during previous 3 yrs., including dates & locations:

Previous Employers (past 7 years)

Date Employed
Reason for leaving
Has your motor vehicle license ever been revoked or suspended?
If yes, give dates and reason for revocation or suspension

I certify 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.

Applicant’s Signature