EmailMe Form - Precision Pipeline INC. CDL

Position Applying for: *

Name *

First Last

Social Security #

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

List Addresses for Past 3 Years *

Driver's License Information: List all Licenses held within the past 3 years.

Text Grid *

	#	Class	State	Exp. Date
License #
License #
License #

Add more here

Have you ever had any driver's License denied, suspended, revoked or cancelled by any state agency? *

YES

NO

If YES, give state of issuance and explanation of the circumstances.

Driving Experience: List types of equipment, dates and approx miles driven.

List all traffic violations/convictions for the past 3 years, write NONE, if none. *

List all accidents for the past 3 years, write NONE, if none. *

List all Employment for the past 3 years, All Driving jobs for the past 10 years, including any gaps between employers. *

Text Grid *

	Name	Phone #	Business
Reference 1
Reference 2
Reference 3

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For driver applicants of commercial motor vehicles that require a commercial driver's license CDL the applicant must disclose their controlled substance and alcohol status for the requirements of 49 CFR part 40.25(j)

As a prospective driver employee, you will have the right to review information provided by previous employers. You have the right to have errors and information corrected by the previous employers and for that previous employers to resend the correct information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding 3 years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at any time, including when applying or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employers then the five business day deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within 30 days of the prospective employer making them available, perspective Motor Carrier may consider the driver to have waived their request to review the records.

You certify by submitting this application that it was completed by you and that all entries on it and information in it are true and complete to the best of your knowledge.