Driver Employment Application

In compliance with Federal and State Equal Employment Opportunity laws, qualified applicants are considered for positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. 

 

TO BE READ AND SIGNED BY ALL APPLICANTS

I authorize DES-CLAW to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, healthcare providers and other persons form 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 may result in discharge. I understand, also, that I am required to abide by all rules and regulations of DES-CLAW.

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DRIVER APPLICANT ONLY

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and €. I understand that I have the right to:

• Review information provided by previous employers;

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to DES-CLAW; and

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

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U.S. Department of Transportation requires driver applicants to state their date of birth (391.21(b)(2)).
Name(Required)
Current Address(Required)
If at the above residence less than three years, list below all residences for the past three years.
Address #1
Address #2
Address #3

Effective January 6, 2020, CDL drivers are required to provide electronic consent to prospective employers in order for the prospective employer to run a full query on a driver's Clearninghouse record. The Clearninghouse is a secure online database that gives employers, the FMCSA, State Licensing Agencies, and law enforcement personnel real-time information about CDL holders' drug and alcohol violations.

Registered drivers should have their Clearinghouse accounts and contact preferences set up, allowing you, the applicant driver, the ability to respond quickly to query requests from potential employers.

Have you registered on the Clearinghouse?(Required)
No. If "No" you will need to register, and respond to a request from CLAW prior to being offered employment with us. To register visit: https://clearinghouse.fmcsa.dot.gov/register
 

GENERAL

 
Shift(Required)
Work hours(Required)
Can you work on Saturdays?(Required)
Can you work on Sundays?(Required)
Have you worked for DES-CLAW before?
Have you been bonded?(Required)
Do you have a legal right to be employed in the United States?(Required)
Have you been convicted of a felony in the last 7 years?(Required)
If yes, list convictions:
 

DRIVER EXPERIENCE & QUALIFICATIONS

 

LICENSES Driver Licenses held in the past 3 years must be shown

Endorsement(s)(Required)
Endorsement(s)
Endorsement(s)
Have you ever been denied a license, permit or privilege to operate a motor vehicle?(Required)
Has any license, permit or privilege ever been suspended or revoked?(Required)
 

DRIVING EXPERIENCE

Straight Truck(Required)
Class of Equipment
Type of Equipment
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From (M/Y)
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To (M/Y)
Tractor and Semi-Trailer(Required)
Class of Equipment
Type of Equipment
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From (M/Y)
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To (M/Y)
List states operated in during the last five years(Required)
 

ACCIDENT RECORD FOR THE PAST 5 YEARS

Have you had an accident in the past 5 years?(Required)
If checked yes, please fill out the following below.
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Head-On, Rear-End, etc.
Injuries
Material Spill
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Head-On, Rear-End, etc.
Injuries
Material Spill
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Head-On, Rear-End, etc.
Injuries
Material Spill
 

TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 5 YEARS (other than parking violations)

Location
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Location
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Location
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DOT CITATIONS (roadside inspections) for the past 5 years

Location
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Location
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Location
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EDUCATIONAL BACKGROUND

 
Type of school(Required)
Type of School
Name and City
Graduation Date
Course or major
 
List all if attended more than 1 (Ex: College, Truck driving or Technical school, High School, etc.)
 

MAINTENANCE EXPERIENCE & QUALIFICATIONS

 
List course and training in maintenance work
 

JOB FUNCTION Indicate training and experience in the following.

Drive Line Components
Diesel Engine Tune-up and Rebuild
Gas Engine Tune-up and Rebuild
Tire Service
Trailer Repair
Air Conditioning (Cab)
Refrigeration (Cargo)
Body Work
Electrical Repair
Frame and Wheel Alignment
Brakes
Cooling System
Inspections (State/Federal)
General Car Repair
 

SHOP EQUIPMENT Indicate training and experience in the following.

Diagnostic Equipment (Type(s))
Sheet Metal Equipment
Frame & Axle Straightening Equipment
Engine Rebuilding
Diesel Injection Equipment
Electric Welder
Oxyacetylene Welder
Paint Spray Gun
Air Conditioning (Cab)
Refrigeration (Cargo)
ASE Certification(s)
List and specify
 

OTHER EXPERIENCE AND QUALIFICATIONS

 
List special courses or training that will help you as a driver
Which safe driving awards do you hold and from whom
List any trucking, transportation, or other experience that may help in your work with CLAW
List platform equipment you can operate (lift truck, etc.)
List courses or training other than listed elsewhere in this application
List special equipment or technical materials you can work with not listed elsewhere
 

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, zip codes, and phone numbers.

All driver applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years of information on those employers for whom the applicant operated such vehicle.

Note: List employers in reverse order starting with the most recent.

EMPLOYER #1

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Address(Required)
Duties/Responsibilities(Required)
Were you subject to the FMCSRs** while employed?(Required)
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?(Required)
-(Required)
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #2

MM slash DD slash YYYY
MM slash DD slash YYYY
Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #3

MM slash DD slash YYYY
MM slash DD slash YYYY
Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #4

MM slash DD slash YYYY
MM slash DD slash YYYY
Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #5

MM slash DD slash YYYY
MM slash DD slash YYYY
Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #6

MM slash DD slash YYYY
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Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

EMPLOYER #7

MM slash DD slash YYYY
MM slash DD slash YYYY
Address
Duties/Responsibilities
Were you subject to the FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFR part 40?
-
Position
Salary/Wage
Reason for leaving
 

WORK REFERENCES

By providing references you give DES-CLAW consent to contact the listed person(s).  
 

REFERENCE #1

Work Reference #1(Required)
Name
Company
Years known
Relationship & Title
Address(Required)
 

REFERENCE #2

Work Reference #2
Name
Company
Years known
Relationship & Title
Address
 

REFERENCE #3

Work Reference #3
Name
Company
Years known
Relationship & Title
Address
 

TO BE READ AND SIGNED BY APPLICANT

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.
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