Driver Application

Titus Transportation & NEA Logistics

Driver Application

Basic Information

Please check which one you are interested in:


	Dry Van / Refer


	Flatbed

Please check which one you are interested in:


	Owner/Operator


	Company Driver

How did you hear about us?

If you were referred by a driver, who?

Have you ever worked for this company before?


	No


	Yes


	If yes, when?

Provide names of any relatives working for this company:


	Are you currently employed?

	Have you ever been bonded?


	No


	No


	Yes


	Yes


	If no, how long since last employment?


	If yes, name of bonding company:

Have you ever been convicted of a felony? Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.


	No


	Yes


	If yes, explain here:


	Education


	Choose Highest Grade Completed:


	Last School Attended (name & address):

Military Experience

Have you ever served in the US Armed Forces?

Are you currently serving in Military Reserves?

Are you currently serving in National Guard?


	No

	No

	No


	Yes

	Yes

	Yes


	If yes, which branch?

Physical History

The Federal Motor Carrier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.

Date of last DOT physical exam?


	Can you provide a copy?


	No


	Yes


	Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of a foot, leg, hand, or arm?


	No


	Yes

Alcohol and Controlled Substance Statement

The Federal Motor Carrier Safety Regulations 49CFR40.25(j) require all persons applying for a driving position requiring a commercial driver license to answer the following questions.

1) Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?


	No


	Yes

2) Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you performed safety-sensitive transportation work?


	No


	Yes


	3) If you answered yes to either 1 or 2 above, can you provide and / or obtain proof that you have successfully completed the DOT return-to-duty requirements?


	No


	Yes

Driver’s License Information

Information for all driver licenses held in the past 3 years must be shown.


	A) Have you ever been denied a license, permit, or privilege to operate a motor vehicle?


	No


	Yes


	B) Has any license, permit, or privilege ever been suspended or revoked?


	No


	Yes


	C) Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?


	No


	Yes


	If you answered “Yes” to A, B, or C above, explain here:


	Driving Experience


	Class of Equipment

	Straight Truck

Tractor & Semi-Trailer

	Twin

	Other


		Type of Equipment (Van, Tank, Flat, etc)


		Dates From To


		Approximate Total Miles


	List states operated in during the last five years:


	List special courses or training that will help you as a driver:

	List safe driving awards and who awards were presented by:


	Accident History


	List all accidents for the past 3 years.


		Date


	Nature of Accident (Head-On, Rear-End, Upset, etc)


	# of Fatalities


	# of Injuries


	# of Vehicles Towed


	Citation Issued?


	No

	No

	No


	Yes

	Yes

	Yes


	Motor Vehicle Driving Record


	List all traffic convictions and forfeitures for the past 3 years other than parking violations.


		Date


		Location


		Charge


		Penalty


	Employment Record


	The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.


	Start with the last or current position, including any military experience, and work back. You are required to list the complete mailing address, including street number, city, state, and zip code.


		Job 1

	Job 2

		Job 3

		Job 4

		Job 5

		Job 6


		Employer Name


		Supervisor


		Address


		Phone


		Position


		Dates From To


		Salary


		Reason For Leaving


	APPLICANT MUST READ AND ELECTRONICALLY SIGN

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.

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.


	Check box below to confirm you understand this is a legally binding electronic signature.


	Electronic Signature - Enter Full Name Below




	Electronic Signature - Enter Date Below


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