Commercial Driver Application
APPLICANT INFORMATION
First Name
Middle Name
Last Name
Phone
Email
Date Of Birth
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Social Security #
Position
OTR Driver
Local Driver
Owner Operator
Date Available
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Do you have legal right to work in the United States?
Yes
No
HOME ADDRESS
X
Street
City
State
-- Select State --
Other
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
# Of Years At Address
DRIVER LICENSE INFORMATION
X
State
-- Select State --
Other
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Number
Class
Expiration
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Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Yes
No
Has any license, permit, or privilege ever been suspended or revoked?
Yes
No
May we contact your current employer at this time?
Yes
No
EMPLOYMENT HISTORY
X
Employer Name
Street
City
State
-- Select State --
Other
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone
Position Held
Reason For Leaving
From Date
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1990
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To Date
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Pay Rate
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Yes
No
Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
Yes
No
Have you had any accidents in the last 3 years?
Yes
No
ACCIDENT RECORD FOR THE PAST 3 YEARS
Have you had any moving violations in the last 3 years?
Yes
No
MOVING VIOLATIONS
DRIVING EXPERIENCE
X
Class
A
Other
Type
Straight Truck
Tractor & Semi-Trailer
Tractor & 2 Trailers
Tractor & Tanker
Other
Total Miles
Date From
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1980
1981
1982
1983
1984
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1997
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2000
2001
2002
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2006
2007
2008
2009
2010
2011
2012
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2015
2016
2017
2018
2019
2020
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2022
2023
2024
Date To
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EDUCATION
X
School
High School
College
Other
Name
Location
Years Completed
Graduate
Yes
No
CDL Endorsements
None
Tanker
Doubles/Triples
Hazmat
X Endorsement
TWIC
Have you ever had a DUI?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Have you ever been convicted of a misdemeanor?
Yes
No
Have you worked for Crazy Horse Transport LLC in the past?
Yes
No
Date Start
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Date End
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Save