General Information


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. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons form all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. 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). I understand I have the right to:

  • Review information provided by previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Personal Information
List your addresses of residency for the past 3 years.
Employment Information
Accident Records for Past 3 years or more
Head-on, Rear-end, Upset, Etc
Head-on, Rear-end, Upset, Etc
Traffic Convictions and Forfeitures
Traffic Convictions And Forfeitures For The Past 3 Years (Other Than Parking Violations)
Experience and Qualifications
List all driver licenses or permits held in the past 3 years
Driving Experience
Select Years Completed

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