Application for CDL Driving Position This form must be completed if you are applying for a CDL driving position. Applicant InformationName* First Last Email Address* Social Security Number*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Previous 3 Years Residency*Enter all addresses you have resided at for the past 3 years. Please include the full address (street, city, state, zip code). Click on the plus icon to add fields for another residency.AddressLength of Residency Driver Experience and QualificationsLicenses*Please list the information for the licenses that have been issued to you. Click on the plus icon to add fields for another license.State IssuedLicense NumberType of LicenseExpiration Date Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*YesNoPlease Explain*Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?*YesNoPlease Explain.*Has any license, permit, or privilege ever been suspended or revoked?*YesNoPlease Explain*Driving ExperienceList states operated in for last 5 years*List any trucking, transportation, or other experience that may help in your work for this company.List any special equipment or technical materials you can work with other than those already required.Straight TruckType of EquipmentApproximate Number of Miles (total)Start Date End Date Tractor and SemiType of EquipmentApproximate Number of Miles (total)Start Date End Date Tractor-TrailersType of EquipmentApproximate Number of Miles (total)Start Date End Date OthersType of EquipmentApproximate Number of Miles (total)Start Date End Date CertificationThis 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. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history another related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history are made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers, and other persons from 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 company.Before Submitting* I certify that all of the information provided is true. NameThis field is for validation purposes and should be left unchanged.