CDL Driver Application Form - AST Enterprises, Inc

Personal Information

Last Name

First Name

Middle Name

Social Security Number

Present Address

City

State

Zip Code

How long?

Telephone Number and Area Code

Home

Work

Date of Birth

Email

Are you prevented from becoming lawfully employed in the U.S. because of your visa or immigration status?

Yes No

Have you ever been fired or asked to resign by an employer?

Yes No

Have you ever been convicted of a felony?

Yes No

Name of Person to be Notified in Case of Emergency

Telephone Number and Area Code

Education

Military Experience

Did you serve in the U.S. Armed Forces?

Yes No

Driving Experience

All employment for the previous 10 years must be covered below …

Class of Equipment

Dates

How Long

Miles Operated

Driven in (check all that apply)

Rain Snow Fog Ice

+Add More

List geographic areas operated in for last five years.

Show special courses or training that will help you as a driver.

Which safe driving awards do you hold and from whom?

Employment History

All employment for the previous 10 years must be covered…

Name and Address of Employer

Dates Employed (Month/Year)

Position(s) Held and Duties Performed

Salary

Why did you leave?

Name of Supervisor

Title of Supervisor

Phone Number of Supervisor

May we contact?

Yes No

Reason if No

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Driving accidents

Accident Date

Nature of Accident

Fatalities

Injuries

+Add More

Traffic Convictions and Forfeitures for the Past Three Years (Other Than Parking Violations)

Location

Date

Charge

Penalty

+Add More

If they have ever been convicted of a crime

Have you been convicted of a crime in the past ten years?

Yes No

FMCSA Clearinghouse Authorization

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA)

Drug and Alcohol Clearinghouse

I, hereby provide consent to AST Enterprises, Inc. to conduct an annual limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse.
I understand that if the limited query conducted by AST Enterprises, Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to AST Enterprises, Inc. without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for AST Enterprises, Inc. to conduct a limited query of the Clearinghouse, AST Enterprises, Inc. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.

MVR Check

AUTHORIZATION TO OBTAIN CONSUMER REPORT OR MOTOR VEHICLE DRIVING REPORT

The undersigned hereby authorizes the (Name of Employer) or its insurance agency, SeibertKeck Insurance, or its assigns, to obtain copies of consumer reports, including a motor vehicle report, pertaining to me for employment purposes, and for use in rating and/or underwriting insurance for which the above named employer may apply, and any renewal thereof. I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I do hereby authorize such use.

Date:

Signed:

Printed Name:

State Licensed in

State Drivers License Number

Date of Birth

Application for Employment

Personal Information

Education

Military Experience

Driving Experience

Employment History

Driving accidents

Traffic Convictions and Forfeitures for the Past Three Years (Other Than Parking Violations)

If they have ever been convicted of a crime

FMCSA Clearinghouse Authorization

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA)

Drug and Alcohol Clearinghouse

MVR Check

AUTHORIZATION TO OBTAIN CONSUMER REPORT OR MOTOR VEHICLE DRIVING REPORT

HOW CAN WE
HELP YOU?

Application for Employment

Personal Information

Education

Military Experience

Driving Experience

Employment History

Driving accidents

Traffic Convictions and Forfeitures for the Past Three Years (Other Than Parking Violations)

If they have ever been convicted of a crime

FMCSA Clearinghouse Authorization

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA)

Drug and Alcohol Clearinghouse

MVR Check

AUTHORIZATION TO OBTAIN CONSUMER REPORT OR MOTOR VEHICLE DRIVING REPORT

HOW CAN WE HELP YOU?

HOW CAN WE
HELP YOU?