Employment History: All driver applicants for driving in interstate commerce must provide the following information on all employers during the preceding 3 years. Please list complete mailing address, street number, city, state and zip code.
Applicants to drive a commercial motor vehicle * in intra- or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.
Please list employers in reverse order starting with the most recent
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.
The federal Motor Carrier Safety Regulations, Title 49: United States Code of Federal Regulations, Section 382.301 Pre-Employment testing requirements apply to driver-applicants of this company.
382.301 Testing Requirements
a) A motor carrier shall require a driver-applicant who the motor carrier intends to hire or use to be tested for controlled substances as a prequalification condition.
b) A driver-applicant shall submit to controlled substances testing as a prequalification condition.
c) Prior to urine sample collection- under 382.113 of this subpart- a driver-applicant shall be notified that the sample will be tested for the presence of controlled substances.
As a condition of my Employment Application, I consent to the urine sample collection and controlled substances testing.
I understand a positive test result for controlled substances is based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this company.
The Medical Review Officer will maintain the results of the Urinalysis Test. Both negative and positive results will be reported to the company.
My written authorization is required for the Urinalysis Test results to be given to other parties.
I have read and understand the above conditions for the Pre-Employment Urinalysis Consent Agreement.
Motor Vehicle Driver's
Certification of Compliance with Driver License Requirements
Motor Carrier Instructions:
The requirements in Part 383 apply to every driver who operates interstate, intrastate or foreign commerce and who operates a vehicle weighing 26,001 lbs. or more; can transport more than 15 people; or transports hazardous materials that require placarding.
The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 lbs. or more; can transport more than 15 people; or transports hazardous materials that require placarding.
Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements with which you as a driver must comply. They are listed as follows:
The following driver's license is the only one I possess:
DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.
Previous Employee Investigations and & Inquiries
I hereby authorize the above named company to release any and all information to Steward Transportation, concerning my performance, conduct, accident record and all required DOT drug and alcohol related information while previously employed as a commercial motor vehicle operator for the previous 3 years from the date of this form, as specified and required by the Federal Motor Carrier Safety Regulations (Part 391.23 Investigation and Inquiries).
In connection with- and for the duration of -my employment (including contract for services) with you; I understand that investigative background inquiries are to be made on myself including consumer, driving, and other reports. This information- in whole or in part- will be obtained from:
CDTA Your National Compliance Solution
1011 Camino Del Rio South, Suite 200, San Diego, CA 92108 888-908-CDTA (2381)
These reports will include information regarding my work habits, experience and performance along with reason for termination by previous employers. Further, I understand that you will be requesting information from various federal, state and other agencies which maintain records concerning any past activities related to my driving.
The information requested above is required by Part 391.23 for the U.S. Department of Transportation Motor Carrier Safety Regulations.
Former Employer: Please rate the applicants performance. It will be held in strict confidence.