Current Drivers License
Another previous driver's license
Accident Record For Past 3 Year or More
Traffic Conviction and Forfeitures for the Past 3 Years
NOTE: DOT requires that employment for at least 3 Years and/or commercial driving experience for the past 10 years be shown
To be read and signed by applicant
This certifies this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
I also understand that the information I provide regarding current and/or previous employers may be used and previous employers will be contacted for the purpose of investigating my safety performance history as required by 49 CFR §391.23(d) and (e). I understand that I have the right to:
- Review information provided by previous employers.
- Have errors in the information corrected and for those previous employers to re-send the corrected information to the prospective employer.
- Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.