OTR Driver Application
Basic Information
Please enter all relevant driver information in the fields below.
Personal Information
Please enter all relevant driver information in the fields below.
Emergency Contact
Primary Contact
Secondary Contact
Tertiary Contact
Driver Details
Current Driver's License Class
Current Driver's License State/Province
Qualifications
If yes, please explain below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.
Driver History
Please answer the following questions as accurately as possible.
Please enter the following information:
e.g. Date. City and State. PV or CMV. Speeding 10 mph over limit.
Please enter the following information:
e.g. Date. Green Bay, WI. CMV. 1 injury, 0 fatalities. Lane change at 55 mph.
Please enter the following information:
e.g. Date. Chicago, IL. 1 fatality. PV. Ran a stop sign and T-boned a car.
Please enter the following information:
e.g. Date. Failed to appear in court.
Please enter the following information:
e.g. Date. From failure to appear suspension.
Driving Experience
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.
Additional Experience