t Safety Portal
Applicant’s Name: *
Applying for what Company: *
Terminal Location: *
Email Address: *
Phone: *
Birthdate: *
CDL License#: *
CDL STATE: *

APPLICANT’S PLEASE TYPE YOUR INITIALS IN THE SPACE BESIDE EACH REQUIREMENT THAT YOU MEET OR EXCEED

Minimum age….22

12 Months of verifiable all-weather experience with a tractor-trailer and/or with the type vehicle to be driven in the job for which you are applying. (past five years)

Physically qualified with a current Long Form DOT Physical within the past 12 months.

No more than 4 moving violations within the previous three(3) years of which no more then one can be considered a “Serious” violation under US DOT Standards (see FMSCR 383.5) Note: Poor/Bad driving records beyond three years are considered & may prevent qualification!
No reckless/Careless Driving convictions within three years, never in a commercial vehicle.
Must have a valid CDL from state of residence.
No CDL driving suspensions within the past three(3) years, exception one event of failing to pay a ticket timely,(unintentionally)
No *Major Preventable Highway Accident within the past 5 years.
No more then 2 minor preventable accidents within the past three(3) years.
No DUI/DWI (Alcohol or Drugs) within the past 5 years and never in a commercial vehicle. (no more then one DUI/DWI ever).
No convictions for the possession and/or use of Controlled Substances or Illegal Drugs within the past 5 years.
No convictions ever for the manufacturing and/or distribution of Controlled Substances or Illegal Drugs.
No Felony Convictions, criminal or traffic within the past 10 years. (“Special Circumstances” cases will be reviewed , example bad checks several years ago, etc.)
No Prior positive DOT Drug or Alcohol Tests within the past 5 years. (Example: a “positive random”, a “positivepost-accident”, or a “positive reasonable suspicion” drug test.)
*A Major Preventable Highway Accident is:
A Major Preventable Highway Accident, whether cited or not, that involves either:
1. Personal injury that requires immediate emergency medical treatment away from the scene
2. Extensive property damage
3. The involvement of 3 or more vehicles
By signing/printing below I am certifying that I have read and understand the above “Driver Minimum Qualifications” and that my initials in the space beside each minimum requirement is certification that I meet or exceed each and every minimum requirement. Company listed on this form may/will use the information obtained to perform a safety, employment verification and background investigation. I consent and provide the above information.
Print Name: *
Date: *
Signature: *

WARNING: FALSIFICATION WILL RESULT IN DISQUALIFICATION!