CDL Driver History | Brady Trucking Co

CDL Driver Road History

The purpose of this application is to determine whether the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.

INSTRUCTIONS TO APPLICANTS : Please answer all questions. If the answer to any question is “No” or “None,” do not leave the item blank, but write “No” or “None.” This is important!

Driving History

Straight Truck (Number of Years and Date)

Tractor and Semi-Trailer (Number of Years and Date)

Tractor Two-Trailers (Number of Years and Date)

Other (Number of Years and Date)

Approximate Total Miles

List States Operated In For Past Five Years

List Special Courses/Training Completed (PTD/DDC, Haz Mat, etc)

List Any Safe Driving Awards You Hold And From Whom

Motor Vehicle Accident Record (Past Three Years)

Date of Accident

Nature of Accident

Location of Accident

No. of Fatalities

No. of Injured People

Date of Accident

Nature of Accident

Location of Accident

No. of Fatalities

No. of Injured People

Date of Accident

Nature of Accident

Location of Accident

No. of Fatalities

No. of Injured People

Date of Accident

Nature of Accident

Location of Accident

No. of Fatalities

No. of Injured People

Date of Accident

Nature of Accident

Location of Accident

No. of Fatalities

No. of Injured People

Traffic Convictions / Violations & Forfeitures

(Past Three Years Not Counting Parking Violations)

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Driver's License

(list each unexpired commercial motor vehicle operator’s license or permit that has been issued to you)

State

License No.

Type

Endorsements

Expiration Date

State

License No.

Type

Endorsements

Expiration Date

State

License No.

Type

Endorsements

Expiration Date

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

Yes

B. Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked?

Yes

C. Have you ever tested positive or refused a DOT drug or alcohol pre-employment test within the past two years from an employer who did not hire you?

Yes

D. Have you ever been convicted of a felony?

Yes

If the answers to A, B, C, or D is “YES”, give details of the facts and circumstances

It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty. I give Brady Trucking and its agents or representatives the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability for damages Brady Trucking and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. It is agreed and understood that this application for qualification in no way obligates Brady Trucking to employ me. It is agreed and understood that if qualified to operate Brady Trucking equipment, I may be on an introductory period, during which I may be disqualified without recourse. 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

Thanks for submitting!