List at least the most recent Three (3) years of residency History.
No person whom 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 lat 3 years.
Accident Record for the Past 3 Years
Traffic Convictions or Forfeitures for the past 3 years (other than parking violations)
The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all for the past 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 10 years). Any gaps in employment in excess of one (1) month must be explained.
Start with the last or most 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 code and complete all of information requested.
I authorize you to make investigations (including but not limited to contacting current and past employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I herby release employers, schools, health care providers, and other persons from liability in responding to inquiries and releasing information in connection to my application.
In the event of employment, I understand that false and/or misleading information given in my application or interview may result in discharge. I also understand that I am required to abide by all rules and regulations of the company.
I understand that the information I provide regarding my current and/or previous employers may be used , and those employers will be contacted for the purposes of investigating my safety performance history as required by 49 CFR 391.23
I understand that I have the right to:
- Review the information provided by
- Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer;
- And Have a rebuttal statement attached to the erroneous information, if the previous employers and I cannot agree on the accuracy of the information.
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than is required by the Federal Motor Carrier Safety Regulations.