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

    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