Driver Application Form

Name*
First Last
Email*
Address*
Street Address City State ZIP Code
Phone*
Mobile*
Information
How did you learn about the company?
Have you ever been employed by the company before?
- No
- Yes
Education
High School Name
Did you graduate?
- No
- Yes
College Name
Number of years attended?
DOT Requirements
What is your current CDL driver license number?*
What state is your current DOT license from?*
When does your current driver license expire?*
MM slash DD slash YYYY
Do you have a current DOT medical card?*
- No
- Yes
Do you have a CDL A or B license?
If you had a license in any other state within the last 3 years, list the states and driver license numbers:
Has your license been suspended, revoked, withdrawn or denied within the last 3 years?*
- No
- Yes
List all traffic violation convictions (other than parking) within the past 3 years by the date, the charge, town and state of occurences:
List all motor vehicle accidents, in which you were involved within the past 3 years by the date, town & state, # of fatalities, and # of injuries:
While working as a driver, have you ever had a HAZMAT spill?*
- No
- Yes
In compliance with FMCSR Section 40.25, have you ever tested positive, or refused a drug test for an employer?*
- No
- Yes
Driving Experience

Answer this group of questions regarding the last 3 years.
Do you have employment experience driving a CDL Straight Truck?*
- No
- Yes
Do you have employment experience driving a Tractor Trailer?*
- No
- Yes
Do you have experience pulling tandems (2 trailers)?*
- No
- Yes
Do you have experience delivering food?*
- No
- Yes
List all of the geographical areas within the Northeastern US that you have experience driving in?
History of Employment

Federal Motor Carrier Safety Regulations require driver applicants to provide a ten (10) year prior employment history.
Are you currently employed?*
- No
- Yes

Employment History

Employer	Start Date	End Date	Actions

There are no Entries.

Driver Certification and Application Information Agreement

I certify that this application was completed by me, and that the answers given herein are true and complete to the best of my knowledge. I also authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that information I provide regarding current and/or previous employers may be used, and those employers(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 and (e). I understand that I have the right to: - Review information provided by current/previous employers and for those employers to re-send the corrected information to the prospective employer; and - 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.
I agree with the above certification?*
- No
- Yes
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.
I agree to the above misleading information terms of this application*
- No
- Yes

©2019-2024 DiCarlo Distributors, Inc. All Rights Reserved. | Privacy Policy & Disclaimer | Site Map

Designed and developed by Progressive Marketing Group, Inc.
Duplication without prior permission from DiCarlo Distributors, Inc. is strictly prohibited.

Employee Portal

Employer*
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Describe Duties
May we contact this employer?*
- Yes
- No
Was a CDL License Required for this position?*
- Yes
- No
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer?*
- Yes
- No
Did you drive vehicles over 26,000 lbs?*
- Yes
- No

Driver Application Form

Information

Education

DOT Requirements

Driving Experience

Answer this group of questions regarding the last 3 years.

History of Employment

Federal Motor Carrier Safety Regulations require driver applicants to provide a ten (10) year prior employment history.

Driver Certification and Application Information Agreement