Driver Application

Applicant to Complete

(answer all questions - please print)

List your addresses of residency for the past 3 years.

Current Address

Previous Addresses

Employment History

Add dirver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing adress, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 year' informtaion on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

EMPLOYER

Date

Employment History (continued)

Date

Employer

Date

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

*The Federal MOtor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Driving Experience Check Yes or No

Class of Equipment

Class of Equipment

Class of Equipment

Class of Equipment

Class of Equipment

Circle Type of Equipment

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Class of Equipment

Circle Type of Equipment

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Class of Equipment