Online Driver Application

Driver Requirements

  • Valid CDL
  • D.O.T. qualified long form physical
  • Two Calendar years recent verifiable over the road experience
  • No DUI in last 5 years
  • No suspension or revocation in last 5 years
  • No more than one chargeable accident in last two years
  • No more than four minor violations in last three years
  • No more than four different employers in past 2 years
  • Neat and clean appearance, and professional attitude
  • Twenty-four years of age
  • Commercial drivers license
  • Passport, Certificate of Naturalization, or Green Card
Personal information:

First Name *

Middle Initial *

Last Name *

Date of Birth *

Social Security # *

Phone Number *

Emergency Number *

Your Email *

Physical Exam Expiration Date *

Addresses you have resided in the last three (3) years.

Address * City * State * Zip * From * To *
Applying Information

Position you are applying for?

Have you worked for this company before?

If yes, when did you last work for us?
From: To:

Reason for leaving?

How did you hear about us? *

Education History:

Please select the highest grade completed: *

Other education:

Employment History:

49 CFR 391.21(b)(10) and (b)(11)

Provide the requested information for ALL employers for the past three years. You must also list any employers for which you operated a commercial motor vehicle in the past 10 years.

Company 1:

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 2 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 3 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 4 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 5 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 6 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 7 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

Company 8 (Click here to add/remove another company):

Company Name

Supervisor's Name

Address

City

State

Zip

Phone Number

Fax Number

Position Held

From Date

To Date

Reason for Leaving

Were you subject to the FMCSRs* while employed here?

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol?

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designed or used to transport nine or more passengers, or (3) is of any size, used to transport hazardous marerials in a quantity requiring placarding.

Driving Experience:
Class of Equipment* Date From* Date To* Approximate Number of Miles (Total) *
Straight Truck
Tractor and Semi-trailer
Tractor-two trailers
Tractor-three trailers (triples)
Other

List states operated in, for the last five years

List special courses/training competed

List any Safe Driving Awards you hold and from whom

Accident Record:

For Last 3 Years - Including Private Vehicles

49 CFR 391.21(b)(7)

List all motor vehicle accidents in which you were involved during the 3 years preceding the date the Driver Qualification form was submitted, specifying the date and nature of each accident and any fatalities or Personal injuries it caused.

Date* Nature of Accident* Location of Accident* # of Fatalities * # of Injuries *
Traffic Convictions and Forfeitures:

For Last 3 Years - Including Private Vehicles

49 CFR ยง391.21(b)(8)

List all violations of motor vehicle laws or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the 3 years preceding the date the Driver Qualification From was submitted.

Date* Location* State * Charge * Penalty *
License Information

49 CFR 391.21(b)(5)

List all unexpired commercial motor vehicle operator's licenses currently held.

State * License Number * Expiration Date * Type * Endorsements *
License Suspensions, Revocations & Denials

49 CFR 391.21(b)(9)

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
      If yes, please explain:

Has any license, permit or privilege ever been suspended, revoked or canceled?
      If yes, please explain:

Is there any reason you might be unable to perfom the functions of the job for which you have applied (as described in the job description)?
      If yes, please explain:

Have you ever been convicted of a felony?
      If yes, please explain:

Personal References

List three persons for references, other than family members, who have knowledge of your safety habits.

Name * Address * Phone *
License Suspensions, Revocations & Denials

This certifies that this Driver Qualification Form was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. 49 CFR 391.21(b)(12).

I understand and agree that drug and alcohol testing will be performed in accordance with 49 CFR part 40 and any additional testing as required by the Company. Failure of any test, or a failure to submit to a test as requested, will be considered grounds for nonconsideration. I also understand and agree that failure of any test required by 49 CFR part 40 will be released to USIS (or any equivalent service as determined or utilized by the Company). I authorize the release of any controlled substance and/or alcohol test result in response to any inquiry regarding my work history with Straight Line Trans Inc.

I understand that it is Straight Line Trans Inc policy to maintain practices, which prevent discrimination against my person on the basis of race, creed, sex, religion, national origin, or any other protected classification.

I understand and agree that this Driver Qualification Form and other related documents will be retained for no longer than 30 days from the date of submission. At the conclusion of that time, if I have not been qualified by the Company and I still wish to be considered for qualification, it will be necessary for me to complete another Driver Qualification Form.

I understand and agree that any misrepresentation of information shall be considered an act of dishonesty and grounds for nonconsideration.

I understand and agree that this form does not obligate Straight Line Trans Inc in any way. I understand that the information in this qualification form will be used for qualification purposes and that prior employers may be contacted for the purpose of investigation as required by 49 CFR 391.23.

I understand and agree that this form must be signed by me in order to commence with the qualification process with Straight Line Trans Inc. Failure to sign this form will result in nonconsideration for qualification. Facsimile and electronic signatures shall be considered original signatures.

* I understand and acknowledge.

* You must agree to the terms before submitting the application.