OTR Driver Application

Basic Information

Please enter all relevant driver information in the fields below.

First name

Last name

Email Address

Phone Number

 

Personal Information

Please enter all relevant driver information in the fields below.

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

 

Emergency Contact

Primary Contact

First Name

Last Name

Relationship

Phone Number

Secondary Contact

First Name

Last Name

Relationship

Phone Number

Tertiary Contact

First Name

Last Name

Relationship

Phone Number

 

Driver Details

Date of birth

Social Security

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

Current Driver's License Class

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?

 

Upload CDL image

 

Education

Highest Grade Completed

School name

School Address

City

State

Zipcode

 

Qualifications

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