DriveLink Commercial Driver Application

Please take your time to fill out all areas of the application. Be as complete and accurate as possible. If there is a question you are unsure of, leave it blank. If you are notified that a field is required, please complete it to the best of your knowledge before submitting.

Please attach a copy of your Driver’s License and Medical Certification at the end of the application.

Page 1 of 7 - General Application Information

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Application For Employment - Commercial Driver

In compliance with Federal and State Equal Employment Opportunity Commission (EEOC) laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other protected classification under local, state or federal law.
Date of Application Date of Application / MM / DD YYYY
Name Name First Middle Last
Do you have the legal right to work in the United States?

Do you have the legal right to work in the United States? Yes No
PERSONAL INFORMATION

All questions on this form must be completed.
Date of Birth Date of Birth / MM / DD YYYY
Social Security Number
Are you currently employed?

Are you currently employed? Yes No
Email
Mobile Phone Mobile Phone - ### - ### ####
Can the phone number listed receive text messages?

Can the phone number listed receive text messages? Yes No
Is there any reason you would not be able to perform the functions of the job for which you are applying, with or without reasonable accomodation?

Is there any reason you would not be able to perform the functions of the job for which you are applying, with or without reasonable accomodation? Yes No
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Employment History

List employers starting with you most current first.

All drivers must provide the following information on all employers during the preceding three years. List complete address and phone number for each employer. If applying for a position driving a commercial motor vehicle* you must also provide an additional seven years of employment information for those employers for whom the applicant operated a commercial motor vehicle (a total of 10 years). Your present and previous employers will be contacted for the purpose of investigating your safety performance history as required by 391.23 of the FMCSRs.
Present or most recent EMPLOYER
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Position Held
From (Start Date) From (Start Date) / MM / DD YYYY
To (End Date) To (End Date) / MM / DD YYYY

If still employed please leave blank
Reason For Leaving?
Contact Person Contact Person First Last
Contact Phone Number Contact Phone Number - ### - ### ####
Were you subject to FMCSRs?

Were you subject to FMCSRs? Yes No
Were you subject to DOT Drug/Alcohol Testing?

Were you subject to DOT Drug/Alcohol Testing? Yes No
Previous Employment
EMPLOYER
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Position Held
From (Start Date) From (Start Date) / MM / DD YYYY
To (Start Date) To (Start Date) / MM / DD YYYY
Reason For Leaving
Contact Person Contact Person First Last
Contact Person Phone Number Contact Person Phone Number - ### - ### ####
Were you subject to the FMCSRs?

Were you subject to the FMCSRs? Yes No
Were you subject to DOT Drug/Alcohol Testing?

Were you subject to DOT Drug/Alcohol Testing? Yes No
EMPLOYER
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Position
From (Start Date) From (Start Date) / MM / DD YYYY
To (End Date) To (End Date) / MM / DD YYYY
Reason For Leaving
Contact Person Contact Person First Last
Contact Person Phone Number Contact Person Phone Number - ### - ### ####
Were you subject to the FMCSRs?

Were you subject to the FMCSRs? Yes No
Were you subject to DOT Drug/Alcohol Testing?

Were you subject to DOT Drug/Alcohol Testing? Yes No
Employment History & Safety Performance Disclosure

All applicants are required to provide complete and accurate employment information for all employers during the preceding three (3) years, including full company name, address, and phone number.

If applying for a position that involves operating a commercial motor vehicle (CMV), applicants must also provide an additional seven (7) years of employment history for any positions in which a CMV was operated, for a total of ten (10) years, in accordance with federal regulations.

Please note: Upon hire, you will be required to disclose and verify all employers for the past ten (10) years, regardless of position, as part of the driver qualification process.

All previous employers may be contacted to obtain safety performance history information as required under 49 CFR §391.23 of the Federal Motor Carrier Safety Regulations.

Failure to provide complete and accurate information may result in disqualification from consideration or termination of employment if discovered after hire.

Employment History & Safety Performance Disclosure All applicants are required to provide complete and accurate employment information for all employers during the preceding three (3) years, including full company name, address, and phone number. If applying for a position that involves operating a commercial motor vehicle (CMV), applicants must also provide an additional seven (7) years of employment history for any positions in which a CMV was operated, for a total of ten (10) years, in accordance with federal regulations. Please note: Upon hire, you will be required to disclose and verify all employers for the past ten (10) years, regardless of position, as part of the driver qualification process. All previous employers may be contacted to obtain safety performance history information as required under 49 CFR §391.23 of the Federal Motor Carrier Safety Regulations. Failure to provide complete and accurate information may result in disqualification from consideration or termination of employment if discovered after hire. I Acknowledge and Agree
EXPERIENCE AND QUALIFICATIONS - DRIVER
Driver License Number
State
Type (A, B, etc.)

Please note that we require CLASS A CDL Holders Only for this application. If you do not have a CLASS A Commercial Drivers License, please do not proceed with the rest of this application.
CDL Expiration Date CDL Expiration Date / MM / DD YYYY
Endorsement (Check All that Apply)

Endorsement (Check All that Apply) T – Double/Triple Trailers N – Tanker Vehicle H – Hazardous Materials (HazMat) X – Tanker/HazMat Combination E – Automatic Transmission Only S – School Bus P – Passenger Other Other

Please answer the following questions:
Please answer the following questions:	Yes	No
Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Have you ever been denied a license, permit or privilege to operate a motor vehicle?Yes	Have you ever been denied a license, permit or privilege to operate a motor vehicle?No
Has any license, permit or privilege ever been suspended or revoked?	Has any license, permit or privilege ever been suspended or revoked?Yes	Has any license, permit or privilege ever been suspended or revoked?No
Have you tested positive for, or refused to take, a pre-employment or random Drug and/or Alcohol test in the past Three (3) years?	Have you tested positive for, or refused to take, a pre-employment or random Drug and/or Alcohol test in the past Three (3) years?Yes	Have you tested positive for, or refused to take, a pre-employment or random Drug and/or Alcohol test in the past Three (3) years?No

**If you answered yes to any of these questions, please provide details**
CDLIS Acknowledgment

I certify that I have listed all Commercial Driver’s Licenses held within the past ten (10) years and authorize the company to obtain my driving record through CDLIS and applicable state agencies. I understand that failure to disclose this information may result in disqualification or termination.

CDLIS Acknowledgment I certify that I have listed all Commercial Driver’s Licenses held within the past ten (10) years and authorize the company to obtain my driving record through CDLIS and applicable state agencies. I understand that failure to disclose this information may result in disqualification or termination. Agree
DRIVING EXPERIENCE
Tractor Trailer Years of Experience

Please answer the following questions:
Please answer the following questions:	Yes	No
In the Past 5 Years have you had any DOT recordable Accidents?	In the Past 5 Years have you had any DOT recordable Accidents?Yes	In the Past 5 Years have you had any DOT recordable Accidents?No
In the Past 5 Years have you had any Hours of Service Violations?	In the Past 5 Years have you had any Hours of Service Violations?Yes	In the Past 5 Years have you had any Hours of Service Violations?No
In the Past 5 Years have you had any Traffic Convitions, Tickets etc..	In the Past 5 Years have you had any Traffic Convitions, Tickets etc..Yes	In the Past 5 Years have you had any Traffic Convitions, Tickets etc..No
In the Past 5 Years have you had any Forfeitures?	In the Past 5 Years have you had any Forfeitures?Yes	In the Past 5 Years have you had any Forfeitures?No

EXPERIENCE AND QUALIFICATIONS - OTHER
Show any trucking, transportation or other experience that may help in your work for this company:
List courses and training other than those shown elsewhere in this application:
PLEASE READ AND SIGN BELOW
Applicant Certification, Authorization & Disclosure

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.

I authorize DriveLink Services, LLC, and its co-employment partner Peoplease, LLC, including all affiliated entities such as Transport Leasing/Contract, Inc., Payroll Plus Corporation, and The Labor Source, Inc., to make such investigations and inquiries of my personal, employment, financial, and other related matters as may be necessary in arriving at an employment decision. I understand that consumer reports may be requested from consumer reporting agencies such as HireRight. These reports may include, but are not limited to: previous employer verifications, reasons for termination, accident history, driving records, workers’ compensation claims, and other relevant background information. I further understand that such reports may contain information from federal, state, or other agencies.

I hereby release all employers, schools, healthcare providers, and other persons or entities from any and all liability in responding to inquiries and releasing information in connection with my application. I further authorize Peoplease, LLC to release any and all information regarding myself to DriveLink Services, LLC and any other Peoplease Worksite Employer clients with whom I may be co-employed.

I understand that I have the right to review information provided to DriveLink Services, LLC and/or Peoplease, LLC by my previous employers and to have any errors in such information corrected by those employers, as provided under Section 391.23(i) of the Federal Motor Carrier Safety Regulations (FMCSRs). To exercise this right, I must submit a written request to my prospective employer.

I authorize, pursuant to 49 CFR Part 40 of the FMCSRs, the release of information from my DOT-regulated drug and alcohol testing records by my previous employers to HireRight for the sole purpose of transmitting such records to DriveLink Services, LLC, Peoplease, LLC, and its affiliates, including Transport Leasing/Contract, Inc., Payroll Plus Corporation, and The Labor Source, Inc., and their respective representatives, agents, and clients. This authorization includes the release of the following information for the preceding three (3) years:
(i) alcohol tests with a result of 0.04 or higher;
(ii) verified positive drug tests;
(iii) refusals to be tested (including verified adulterated or substituted results);
(iv) other violations of DOT drug and alcohol testing regulations;
(v) information obtained from previous employers of drug and alcohol rule violations; and
(vi) documentation of completion of the return-to-duty process, if applicable.

I further authorize my worksite employer, including DriveLink Services, LLC, to submit copies of my current and future drug and alcohol testing results to Peoplease, LLC and its affiliates. This authorization shall remain in effect for the duration of my employment and shall expire if and when my worksite employer is no longer a client of Peoplease, LLC and its affiliates.

I understand that if any prior employer, carrier, company, or school furnishes HireRight with information concerning the above-listed items, I also authorize the release of the dates of my negative drug and/or alcohol tests (below 0.04) during the prior three (3) years, as well as the names and contact information of any Substance Abuse Professionals (SAPs) who evaluated me during that time.

DriveLink Services, LLC and Peoplease, LLC, including Transport Leasing/Contract, Inc., Payroll Plus Corporation, and The Labor Source, Inc., participate in E-Verify. If hired, I understand that information from my Form I-9 will be provided to the Social Security Administration and, if necessary, the Department of Homeland Security to confirm my authorization to work in the United States.

In the event of employment, I understand that false or misleading information given in my application or during the interview process may result in disqualification or termination of employment. I further understand that I will be required to comply with all policies, procedures, and regulations of DriveLink Services, LLC and any applicable co-employment requirements under Peoplease, LLC.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

DriveLink Commercial Driver Application

DriveLink Commercial Driver Application

Page 1 of 7 - General Application Information

Application For Employment - Commercial Driver

PERSONAL INFORMATION

Employment History

Previous Employment

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVING EXPERIENCE

EXPERIENCE AND QUALIFICATIONS - OTHER

PLEASE READ AND SIGN BELOW