DOT requires employment for three years and/or commercial driving experience for the past 10 years to be shown.

This refers to any gaps in employment history.

I understand I must provide my complete employment history for the past three years, and all CDL required employment for the seven years preceding that. Any gaps in employment longer than one month are explained as follows.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, l understand that false or misleading information given in my application or interviews may result in discharge. l understand also that I am required to abide by all rules and regulations of the Company.

I understand information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). r understand that I have the right to:

• Review information provided by the previous employers;

• Have errors in the information corrected by previous employers and for those previous 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.

This certifies this application was competed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1987. They are as follows:

1. You, as a commercial vehicle driver, may not possess more than one license.

2. If you currently have more than one license, you should keep the license from your state of residence and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. lf a multiple license has been lost, stolen, or destroyed, you should close your record by notifying the state of issuance that you no longer want to be licensed by that state.

3. Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver's license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other than parking), you must report it to your employing motor carrier and the state that issued your license within 30 days.

DRIVER CERTIFICATION: I certify that I have read and understand the above requirements.

The following license is the only one I will possess:

I understand that, as required by the Federal Motor Carrier Safety Regulations and company police, all drivers must submit to alcohol and controlled substance testing as a condition of employment. I also understand that any offer of employment will be contingent upon the results of an alcohol and controlled substance test.

Therefore, I agree to submit to the following alcohol and controlled substance tests in accordance and as defined by the Federal Motor Carrier Safety Regulation and this company's policies:

• Pre-employment, to determine employment eligibility

• Random

• Reasonable suspicion

• Post accident

I certify that I have read, understand, and agree to abide by the condition of this consent and release form.

In accordance with the provisions of Section 604 (b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title 11, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. Your employer may obtain this information from Accufax, Equifax, Transunion, Experian or other vendors of information services.

In conjunction with my employment at Midland Davis Corporation, I consent to the annual release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that are related to my position with the company.

This consent is given in satisfaction of Public Law 18 USC 2721 et.Seq., "Federal Drivers Privacy Protection Act," and is intended to constitute "written consent" as required by this Act.

I hereby provide consent to Midland Davis Corp to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.


I understand that if the limited query concluded by Midland Davis Corp indicates that drug and alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Midland Davis Corp without first obtaining additional specific consent from me.


I further understand that if I refuse to provide consent for Midland Davis Corp to conduct a limited query of the Clearinghouse, Midland Davis Corp must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.