Start New Application

Please complete the fields below to register and begin the application.

First Name: *

Middle Name:

Last Name: *

How did you hear about us?

Applicant Information

Date of birth *

MM/DD/YYYY

Social Security Number *

Repeat Social Security Number *

Phone *

Alt Phone Number:

Email *

Address

Street Address

City

State

Country

Postal code

Do you have a TWIC Card? *

Do you have a passport?

TWIC Card Expiration Date *

MM/DD/YYYY

Upload your TWIC Card *

Residences Previous 3 Years

List residence for previous 3 years if you lived at the above address less than 3 years.

Address I

City I

State I

Postal Code I

Do you want to add another Residence? *

Yes

Address II *

City II *

State II *

Postal Code II *

Drivers License Information

List all driver licenses held within the last 3 years. Enter your first and last name exactly as it appears on your license.

Warning! Triple check the license information for accuracy. If you enter the wrong information, all documents relating to your license will have to be discarded and completed again. Failure to enter accurate license information may result in non-consideration and a rejected application!

First Name *

Last Name *

License Number: *

Repeat License Number: *

Issued *

MM/DD/YYYY

Expires *

MM/DD/YYYY

Class *

Upload Driver License

Please upload a copy of the drivers license specified above. (Supported Formats: .jpg, .png, .gif)

Please upload the FRONT copy of your drivers license.

Drivers License Front *

Please upload the BACK copy of your drivers license.

Drivers License Back *

Medical Certificate

Do you have a Medical Certificate? *

Yes

Medical Certificate Expiration Date *

MM/DD/YYYY

Upload your Medical Certificate *

Experience

Straight Truck

Straight Truck Experience *

Truck-Tractor

Truck-Tractor Experience *

Semi-Trailers

Semi-Trailers Experience *

Doubles/Triples

Doubles/Triples Experience *

Flatbed

Flatbed Experience *

Bus

Bus Experience *

Other

Other Experience *

Straight Truck Experience

Straight Truck Date From *

MM/DD/YYYY

Straight Truck Date To *

MM/DD/YYYY

Straight Truck Approx Miles *

Truck Tractor Experience

Truck-Tractor Date From *

MM/DD/YYYY

Truck-Tractor Date To *

MM/DD/YYYY

Truck-Tractor Approx Miles *

Semi Trailers Experience

Semi-Trailers Date From *

MM/DD/YYYY

Semi-Trailers Date To *

MM/DD/YYYY

Semi-Trailers Approx Miles *

Doubles/Triples Experience

Doubles/Triples Date From *

MM/DD/YYYY

Doubles/Triples Date To *

MM/DD/YYYY

Doubles/Triples Approx Miles *

Flatbed Experience

Flatbed Date From *

MM/DD/YYYY

Flatbed Date To *

MM/DD/YYYY

Flatbed Approx Miles *

Bus Experience

Bus Date From *

MM/DD/YYYY

Bus Date To (MM/DD/YYYY) *

Bus Approx Miles *

Other Experience

Other Date From *

MM/DD/YYYY

Other Date To *

MM/DD/YYYY

Other Approx Miles *

Accidents/Crashes Previous 3 Years

Have you had any accidents/crashes in the last 3 years? *

Yes

Previous Accidents/Crashes Date *

MM/DD/YYYY

Previous Accidents/Crashes Location City/State *

Previous Accidents/Crashes Number of Fatalities *

Previous Accidents/Crashes Number of Injuries *

Hazmat Spill? *

Do you want to add another Accident/Crash? *

Yes

Previous Accidents/Crashes Date II *

MM/DD/YYYY

Previous Accidents/Crashes Location City/State II *

Previous Accidents/Crashes Number of Injuries II *

Previous Accidents/Crashes Number of Fatalities II *

Hazmat Spill? II *

Moving Traffic Violations Previous 3 Years

Have you had any traffic violations in the last 3 years? *

Yes

Previous Moving Traffic Violations Date *

MM/DD/YYYY

Previous Moving Traffic Violations Location City/State *

Offense *

Vehicle Type *

Do you want to add another Violation? *

Yes

Previous Moving Traffic Violations Date II *

MM/DD/YYYY

Previous Moving Traffic Violations Location City/State II *

Offense II *

Vehicle Type II *

Forfeitures Previous 3 Years

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

Yes

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

Yes

C. If yes to either question above, briefly describe the circumstances.

Employment Record

List all employers for the previous 3 years and an additional 7 years if you were employed as a DRIVER.

Employer Name: *

Employer Address *

Employer City *

Employer State *

Employer Postal Code *

Employer Phone *

Employer Fax

Employer Email *

Employment Date From *

MM/DD/YYYY

Employment Date To *

MM/DD/YYYY

Employer Reason For Leaving *

Were you subject to DOT/FMCSA regulations while employed by this carrier?

If you were a driver, choose Yes. *

Yes

Was your job designated as a safety sensitive function, in any DOT regulated mode, subject to the alcohol and controlled substances testing requirements required by 49 CFR Part 40?

Select "Yes" if you are a driver. *

Yes

Do you want to add another previous employer? *

Yes

Employer Name I: *

Employer Address I: *

Employer City I: *

Employer State I: *

Employer Postal Code I: *

Employer Phone I:

Employer Fax I:

Employer Email I: *

Employer Position Held I: *

Employer Date Form I: *

MM/DD/YYYY

Employer Date To I: *

MM/DD/YYYY

Employer Reason For Leaving I: *

Were you subject to DOT/FMCSA regulations while employed by this carrier?

If you held a driving position, click Yes. *

Yes

Was your job designated as a safety sensitive function, in any DOT regulated mode, subject to the alcohol and controlled substances testing requirements required by 49 CFR Part 40?

Please choose Yes if your role was that of a driver. *

Yes

Are you currently enrolled in a DOT drug and alcohol testing consortium? *

Yes

If yes:

Name of Consortium:
Consortium Contact Information (if available):

Enrollment Start Date:

Pre-Employment Employee Alcohol & Drug Test Statement

49 CFR Part 40.25(j) states, as the employer, you must ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process required in 49 CFR Subpart O.

As the prospective employee, have you:

1. Tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. *

Yes

2. If you answered yes to the above question, can you provide documentation of successful completion of DOT return-to-duty requirements (including follow-up tests).

Yes

Safety Performance History Investigation

Safety Performance History Investigation Authorization *

I hereby authorize release of information to this prospective employer from my employment file and my Department of Transportation regulated drug and alcohol testing records. This release is in accordance with DOT Regulation 49 CFR Parts 40.25/382.413/391.23. I understand that information to be released. by my previous employer. is limited to the previous three years, You are released from any and all liability which may result from releasing such information. Pursuant to the federal Fair credit Reporting Act. I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report for investigative consumer report may include. but is not limited o. the following areas: verification of Social Security number: current and previous residences; employment history. including all personal files; education; references; credit history and reports; criminal history. including records from any criminal justice agency In any or all federal, state or county jurisdictions: birth records: motor vehicle records. including traffic citations and registrations and any other public records.

I understand that it is my right to review information provided by previous employers; to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information ; as well as the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree on the accuracy of the information. I understand that if I wish to review previous employer-provided investigative information .I must submit a written request , which may be done at any time , including when applying or as late as 30 days after being employed or being notified of denial of employment . I understand that if I have not arrange to pick up or receive the requested records within thirty(30) days of them becoming available , it may be considered that I have waived my request to review the records.

DRUG & ALCOHOL CLEARINGHOUSE CONSENT FOR LIMITED QUARIES

NOTICE TO DRIVER: The Commercial Drivers License (CDL) Drug & Alcohol Clearinghouse is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations in 49 CFR Part 382. Whether you have committed such a violation or not,

each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both at the time of hire and annually . When conducting an annual inquiry, the motor carrier has the option to request a "limited" report that only indicates whether the Clearinghouse has any information about you.

Before a motor carrier may request a limited report,they must have your written authorization, per $382.701 (b), This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain your full Clearinghouse record.

NOTICE TO MOTOR CARRIER: This consent form authorizes you to run a "limited query" to check whether the Clearinghouse has information about the driver identified below. If it does , then you must obtain a full Clearinghouse record within 24 hours, per $382.701 (b). This consent form must be retained until 3 years after the date of the

last limited query you perform for this driver, based on the authorization below.

I hereby authorize my current employer to conduct limited annual queries of the FMCSA's Drug & Alcohol Clearinghouse to determine if a Clearinghouse record exists for me. This consent is valid from the date shown below until my employment with the employer ends or until I am no longer subject to the drug and alcohol testing requirements under 49 CFR Part 382. I understand that if a limited query indicates that the Clearinghouse contains information about me, I must provide electronic consent within 24 hours, via the Clearinghouse website, for the employer to access my full Clearinghouse record. Refusal to provide such consent will result in my removal from safety-sensitive functions,

RELEASE & DOCUMENTATION OF PRE- EMPLOYMENT TESTING INFORMATION BY APPLICANT/DRIVER REQUIRED BY PART 40.25 (j).

PART 40.25(j) requires Employers to ask Applicant/Driver whether he/she has tested positive or refused to test on any pre-employment alcohol or drug test administered by an Employer to which the Applicant/Driver applied but did not obtain safety sensitive transportation work covered by DOT agency alcohol and drug testing rules during the past two (2) years.

During the past two (2) years have you tested positive on a pre-employment alcohol or drug test administered by Employer to which you applied for but did not obtain a safety sensitive transportation work covered by Department of Transportation (DOT) drug and alcohol testing rules? *

Yes

I confirm that the information provided is correct and true to the best of my knowledge.

Fair Credit Reporting Act

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

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.

Applicant Signature *

Clear

Date Signed *