Employment Application Commercial Driver Application For Employment First Name Middle Name Last Name Address State City Zip Code How long? Date of birth Social Security Number Telephone Cell Phone Email Experience & Qualification-DriverDriver Licenses State License Number Class/Endorsements Expiration Date 49CFR Part 383.21 of the FMCSR states: "No person who operates a commercial motor vehicle shall at any time have more than one driver license's". I certify that i don't have more than one motor vehicle license, the information for which is listed above Driving Experience SIngle Truck Type of Equipment Dates Approx no of mile (Totol) Tractor & Semi Trailer Type of Equipment Dates Approx no of mile (Totol) Tractor & Two-Trailer Type of Equipment Dates Approx no of mile (Totol) Accident Record For past 3 years or more Last Accident Nature of Accident Fatalities Injuries Next Previous Nature of Accident Fatalities Injuries Next Previous Nature of Accident Fatalities Injuries Traffic Convictions and Forfeitures for past 3 years (Other Than parking violation) Location-1 Date Violation Penalty Location-2 Date Violation Penalty Location-3 Date Violation Penalty A) Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B) Has any license, permit or privilege ever been suspended or revoked? Yes No C) Have you ever been disqualified for violations of the FMCSR's Yes No If the answer to any question is YES, Attach reasons for details Employment Records (Please fill below information if any) Last Employer City State Zip Code Position Held Duration Salary Were You subject to FMCSR's while Employed? Yes No Did you perform safety Sensitive functions in any DOT regulated mode subject to Alcohol and controlled substances testing requirements as required by 49 CFR part 40? Yes No Second Last Employer City State Zip Code Duration Position Held Salary Were You subject to FMCSR's while Employed? Yes No Did you perform safety Sensitive functions in any DOT regulated mode subject to Alcohol and controlled substances testing requirements as required by 49 CFR part 40? Yes No Third Last Employer City State Zip Code Position Held Duration Salary Were You subject to FMCSR's while Employed? Yes No Did you perform safety Sensitive functions in any DOT regulated mode subject to Alcohol and controlled substances testing requirements as required by 49 CFR part 40? Yes No Any Gaps in Employment or Unemployment Must be explained, Includes (Dates/Month/Year) And Reasons To Be Read & Sign by Applicant I, Authorize you to make investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in making 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 applications. " I fully understand that information I provide regarding current and/or previous employers may be used and those employers will be contracted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e) In the event of employment, I understand That false or misleading information given in my application or interview may result in discharge, I understand , also, that I am required to abide by all rules and regulations of the companyThis certifies that this application was completed by me and all entries on it and information in it are true and complete in the best of my knowledge. Upload your Signature with Date Send Contact Us We look forward to work with you… Get In Touch Address Park 80 West 250 Pehle Avenue Saddle Brook, NJ 07663 Call Us +1-917-526-3349 Email Us info@kwtransportationlogistics.com Website www.kwtransportationlogistics.com
