APPLICATION Submit Your License Application CDL DRIVER APPLICATIOn application-form 1. Personal InformationEmail* Name* First Last Other Names Used First Date of Birth* MM slash DD slash YYYY Current Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Alt Phone NumberSocial Security* Your information is protected. The lock icon within the browser identifies this site as a secure connection site. SSL Certificate is enabled. Notify In Case of Emergency* First Last Phone*Are You Currently Employed?*NoYesHave You Ever Applied Here Before?*NoYesDate Applied* MM slash DD slash YYYY Have You Had Any Previous Association With This Company?*NoYesIf Yes, Please Provide a Date (MM/YYYY) MM slash DD slash YYYY Position Reason for Leaving Were You Referred to Our Company?*NoYesIf Yes, Please Provide By Whom (Name) Are You Prevented From Lawfully Becoming Employed In This Country Because of Visa or Immigrant Status*NoYesProof of Citizenship or Immigrant Status Is Required upon Employed Days Available for Work (Select All That Apply)* SUN MON TUE WED THU FRI SAT Hours Available* For How LongTEMPLONG TERMHow Much Weight Can You Comfortably Lift? (lbs)* Do You Have Your Own Reliable Transportation To and From Work?*YesNoDesired Pay Rate? (Annually)* 2. Residence Address (List Residence Addresses for the Past 3 Years)Residence 1* MM slash DD slash YYYY MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code Residence 2 (If Applicable) MM slash DD slash YYYY MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code Residence 3 (If Applicable) MM slash DD slash YYYY MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code 3. EducationTruck Driving School Have You Attended Truck Driving School?*YesNoStart Date* MM slash DD slash YYYY Graduation Date* MM slash DD slash YYYY Name of School* Address* City State / Province / Region Grade, High School and College Highest Grade Completed*Grade SchoolHigh SchoolSome CollageBachelors DegreeGEDLast School Attended* Date Last Attended or Graduation Date* MM slash DD slash YYYY Other Education 4. Military StatusHave You Served in the U.S Armed Forces?NoYesPlease answer additional questions below.Branch* Dates* MM slash DD slash YYYY * MM slash DD slash YYYY List Any Special Skills or Training That You Received* 5. Work Experience List below past and present employers for the past three (3) years of employment (and/or commercial driving experience for the past ten (10) years, beginning with your present or most recent. All time must be accounted for, including unemployment.Employer* From: (MM/YYYY)* MM slash DD slash YYYY To: (MM/YYYY)* MM slash DD slash YYYY Phone Number*Type of Vehicle Driven* Address* Street Address City State / Province / Region ZIP / Postal Code Position Held* Name of Supervisor* First Last Reason for Leaving* Accidents?YesNoIf Yes, How Many?01234MoreWere you subject to Federal Motor Carrier Regulations?*YesNoWas this position a Safety Sensitive Function subject to Drug and Alcohol Testing?*YesNoComments (If Any) Add Work Experience (If Applicable)1NoYesEmployer 2 From: (MM/YYYY) MM slash DD slash YYYY To: (MM/YYYY)* MM slash DD slash YYYY Phone NumberType of Vehicle Driven Address Street Address City State / Province / Region ZIP / Postal Code Position Held Name of Supervisor First Last Reason for Leaving Accidents?YesNoIf Yes, How Many?1234MoreWere you subject to Federal Motor Carrier Regulations?YesNoWas this position a Safety Sensitive Function subject to Drug and Alcohol Testing?YesNoComments (If Any) Add Work Experience (If Applicable)2NoYesEmployer 3 (If Applicable) From: (MM/YYYY) MM slash DD slash YYYY To: (MM/YYYY)* MM slash DD slash YYYY Phone NumberType of Vehicle Driven Address Street Address City State / Province / Region ZIP / Postal Code Position Held Name of Supervisor First Last Reason for Leaving Accidents?YesNoIf Yes, How Many?1234MoreWere you subject to Federal Motor Carrier Regulations?YesNoWas this position a Safety Sensitive Function subject to Drug and Alcohol Testing?YesNoComments (If Any) 6. Driving & Related Experience (If Any) Tanker and Semi Tanker Length of Experience Approximate # of Miles Straight Truck Length of Experience Approximate # of Miles Other (Roll-Off, Dump, Flatbed) Length of Experience Approximate # of Miles Doubles/Triples? Forklifts/Moffitts Lifts/Etc List Any Warehouse Experience List the States That You've Driven Regularly What Awards Do You Hold For Safe Driving? (If Any) 7. AccidentsList all accidents that you have been involved in during the past three (3) years, in any type of vehicle, and regardless of whether you feel they were chargeable or non-chargeable. Do you have any accidents to list?Do You Have Accidents To List?*YesNoAdd Accident InformationNoYesDate* MM slash DD slash YYYY Type of Vehicle* Who's Fault?*I was at FaultThe Other Person Was At FaultWere There Fatalities?*YesNoInjuries?*YesNo$ Amount of Damage Add Accident Information (If Applicable)1NoYesDate MM slash DD slash YYYY Type of Vehicle Who's Fault?I was at FaultThe Other Person Was At FaultWere There Fatalities?YesNoInjuries?YesNo$ Amount of Damage Add Accident Information (If Applicable)NoYesDate MM slash DD slash YYYY Type of Vehicle Who's Fault?I was at FaultThe Other Person Was At FaultWere There Fatalities?YesNoInjuries?YesNo$ Amount of Damage 8. Traffic ViolationsList all traffic violations (other than parking violations) that you have been convicted of forfeited bond or collateral during the past three (3) years. Do you have traffic violations to list?YesNoDate* MM slash DD slash YYYY City & State* Charge*Penalty*Personal (POV) or Commercial (CMV)*POVCMVI certify that the above is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past three (3) years.Failure to list all traffic violations may result in your qualifications. 9. Criminal Background InformationHave you ever been convicted of DWI, DUI, Careless or Reckless Driving, 15 mph over the posted speed limit, leaving accident scene, or using a commercial vehicle in commission of a felony?*YesNoDate* MM slash DD slash YYYY Explain* Has your license or privilege to drive ever been suspended or revoked for any reason?*YesNoDate* MM slash DD slash YYYY Explain* Have you ever been convicted of a felony?*YesNoDate* MM slash DD slash YYYY Explain* *Disclosure of this information does not necessarily disqualify you from consideration.10. Driver License StatusList all driver licenses that you presently hold or have held in the past. To add more license information, click "Add". POV CMV Check OneState* License Number*Expiration Date* MM slash DD slash YYYY Endorsements Add More License Information (If Applicable)1NoYesList all driver licenses that you presently hold or have held in the past. To add more license information, click "Add". POV CMV Check OneState License NumberExpiration Date MM slash DD slash YYYY Endorsements Add More License Information (If Applicable)2NoYesList all driver licenses that you presently hold or have held in the past. To add more license information, click "Add". POV CMV Check OneState License NumberExpiration Date MM slash DD slash YYYY Endorsements 11. Alcohol & Control Related Substance TestingHave you tested positive for a controlled substance in the last two (2) years?*YesNoHave you had any alcohol test with a breath alcohol concentration of 0.04 or greater in the last two (2) years?*YesNoHave you refused a required test for alcohol or drugs in the last two (2) years?*NoYesIf you answered Yes to any of the above questions, please give the substance abuse professional's name, address, and phone number for further reference.Name Phone #Address* Address Line 2 City State / Province / Region ZIP / Postal Code * Disclosure of this information does not necessarily disqualify you from consideration.AGREEMENT - Please read the following statement carefully.This certified 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. I also agree that falsified information or significant omissions may result in my disqualification now or at any time. In connection with my application for qualification with ESP Fueling, LLC dba ESP Transport, I understand that an investigative consumer report will be requested that will include information as to my character. credit history, work habits, performance, experience, drug and alcohol test results, driving record and experience, as well as any reason for termination of my qualifications including any results from previous employers. Further, I understand that you will be requesting information concerning my driving record and/or information from various state agencies which remain records concerning, credit record, criminal history, traffic offenses and accidents, as well as information concerning my previous driving record requests made by others from such state agencies. I hereby authorize ESP Fueling, LLC dba ESP Transport to obtain the above described information, and agree that such information, and my employment history with you if I am qualified, will be supplied to other companies which subscribed to consumer reporting services. In accordance with Sector(s) 382.405, 382.413 and 391.23 of the Federal Motor Carrier Safety Regulations, I authorize any and all persons and/or institutions to provide any relevant information, including my alcohol and controlled substance testing/training, that may be required to complete my qualification and I agree to release them from any and all liability for supplying said information. Finally, prospective employers are required to notify driver applicants for their due process rights as specified in 391.23(i) regarding the information received as part of the background investigation. In accordance with section (i)(1), I understand my right to be expressly notified with Department of Transportation regulate employment during the preceding three (3) years-via the application for or other written document prior to any hiring decision and that I have the following rights regarding the investigative information that will be provided: (i)(1)(i) The right to review information provided by previous employers; (i)(1)(ii) The right to have errors in information corrected by the previous employer and for that previous employer to re-send the correct information; (i)(1)(iii) The right to have a rebuttal statement attached to the alleged erroneous information, it the previous employer and the driver cannot agree; (i)(2) Drivers who have previous Department of Transportation regulated employment history in the preceing three (3) years,and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified od denial of employment. The prosepctive employer must provide this information to the applicant within five (5) business days, the the five-business days deadline will begin when the prospective employer received the requested safety peformance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records. This certified that this application was complete by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Signature* NameThis field is for validation purposes and should be left unchanged.
