OTR Driver Application

Basic Information

Please enter all relevant driver information in the fields below.

First name

Last name

Email Address

Cellular Number

Personal Information

Please enter all relevant driver information in the fields below.

Address

Street Address

City

State

Zipcode

Have you lived at your address for more than 5 years?

YesNo

How long have you lived at your current address?
Other Addresses - Past 5 Years

Driver Details

Date of birth

Social Security

Current Driver's License Number (Include all zeros in your license number.)

Current Driver's License Class (Class C or D are considered Regular License.)

Current Driver's License Expiration Date

Current Driver's License State/Province

Hazmat Endorsement?
DeniedNoYes
Doubles/Triples Endorsement
YesNo
Tanker Endorsement
YesNo
Have you held other licenses in the past 5 years?
NoYes
Other State(s) and License Numbers Held in the Past 5 Years

Have you ever served in the U.S. Armed Forces?

NoYes

Which brand of service?

Upload CDL image

Education

Highest Grade Completed

School name

School Address

City

State

Zipcode

Qualifications

Are you subject to any employment or non-compete agreement with any company or employer (current or former) that may prohibit you from working for Milam Transport?

NoYes

Confirm the following: I am completing this application based on my own evaluation of Milam Transport, and Milam Transport has not encouraged, requested, or asked me to breach an employment contract with any employer.

YesNo

Do you have the legal right to live and work in the United States?

YesNo

Have you ever been convicted of any drug or alcohol related offenses while operating a motor vehicle?

YesNo

Have you ever been employed/leased with Milam Transport?

YesNo

Have you ever tested positive or refused to take a drug or alcohol test, to include pre-employment tests (even if not hired/leased)?

NoYes

Have you ever been convicted of a felony?

NoYes

If yes, please explain below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Upload Medical Card image

Driver History

Please answer the following questions as accurately as possible.

Have you had any moving violations in the last 5 years in a personal vehicle or 7 years in a commercial vehicle?

NoYes

Please enter the following information:
e.g. Date. City and State. PV or CMV. Speeding 10 mph over limit.

Were you involved in any accidents or incidents in the last 4 years in a personal vehicle or 5 years in a commercial vehicle, even if not at fault?

NoYes

Please enter the following information:
e.g. Date. Green Bay, WI. CMV. 1 injury, 0 fatalities. Lane change at 55 mph.

Have you ever been involved in any fatality accidents while operating a personal or commercial vehicle?

NoYes

Please enter the following information:
e.g. Date. Chicago, IL. 1 fatality. PV. Ran a stop sign and T-boned a car.

Have you ever had your drivers license or permit suspended, revoked, or disqualified for any reason?

NoYes

Please enter the following information:
e.g. Date. Failed to appear in court.

Have you ever been convicted of driving with a suspended, revoked, or disqualified drivers license or permit?

NoYes

Please enter the following information:
e.g. Date. From failure to appear suspension.

Driving Experience

Class of Equipment

Type of Equipment (Van, Tank, Flat, etc.)

Dates (From-To)

Approximate Total Miles

Check mark all states you operated in during the last five years:

Select All

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Employment Record

The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.

Start with the last or current position, including any military experience, and work back (Attach separate sheet if necessary.) You are required to list the complete mailing address: street number, city, state and zip code.

Employer

Supervisor's Name

Full Address

Phone

Position Held

From (Mo./Yr.) - To (Mo./Yr.)

Salary

This is my current job

NoYes

How long since leaving last employment?

Reason for leaving

Were you subject to the federal motor carrier safety regulations while employed/leased by this employer/lessor?

YesNo

Did you perform any safety sensitive functions in this job, regulated by DOT and subject to drug and alcohol testing requirements as required by Federal Regulations 49 CFR part 40?

YesNo

Additional Experience

Have more work experience you want to add?

NoYes

Employer

Supervisor's Name

Full Address

Phone

Position Held

From (Mo./Yr.) - To (Mo./Yr.)

Salary

Reason for leaving

APPLICANT MUST READ AND SIGN BELOW

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.

This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS


IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with MILAM TRANSPORT, LLC (“Prospective Employer”), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize MILAM TRANSPORT, LLC (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

Digitally sign with your mouse below.