Please enter all relevant driver information in the fields below.
First name
Last name
Email Address
Phone Number
Street Address
City
State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinois IndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvania Rhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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
First Name
Last Name
Relationship
Date of birth
Social Security
Current Driver's License Number (Include all zeros in your license number.)
Current Driver's License Class —Please choose an option—ABCD
Original Issue Date
Current Driver's License State/Province
Current Driver's License Expiration Date
Hazmat Endorsement? NoYes
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?
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Highest Grade Completed
—Please choose an option—Attended High SchoolDiplomaAttended CollegeAssiates Degree+
School name
School Address
Do you have the legal right to live and work in the United States?
Have you ever been convicted of any drug or alcohol related offenses while operating a motor vehicle?
Have you ever been employed/leased with Milam Transport?
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?
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
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?
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?
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?
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?
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?
Please enter the following information: e.g. Date. From failure to appear suspension.
Class of Equipment
—Please choose an option—Straight TruckTractorSemi-TrailerTwin
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
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
How long since leaving last employment?
Reason for leaving
Have more work experience you want to add?
