License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

Previously Held Licenses

Previously Held Licenses

Driving Experience

Straight Truck

Tractor & Semi-Trailer

Tractor & 2 Trailers

Tractor & Tanker

Other

Accident Record For The Past 3 Years

First Accident (If Applicable)

Second Accident (If Applicable)

Third Accident (If Applicable)

Traffic Convictions And Forfeitures For The Past 3 Years (Other Than Parking Violations)

If more space is needed please put in in the additional comments section

First Conviction (If Applicable)

Second Conviction (If Applicable)

Third Conviction (If Applicable)

Fourth Conviction (If Applicable)

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) 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 in excess of one (1) month must be explained.

Start with the last or current position, including any military experience, and work backwards(attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information

Current (Most Recent) Employer

Second (Most Recent) Employer

Third (Most Recent) Employer

Education

To Be Read And Signed By Applicant