Driver Application | Nightfall Express LLC

Applicant Information

First Name *

Middle Name

Last Name *

Phone *

Email *

Date of Birth

Social Security #

Date of Application

Position Applied For

Date Available for Work

Legal right to work in the US? *

YES NO

Previous Three Years Residency

Attach additional sheet if more space is needed

	Street	City	State	Zip	# Years
Current
Mailing
Previous
Previous

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license.

Current License

State	License #	Type / Class	Endorsements	Expiration

Previously Held Licenses

State	License #	Type / Class	Endorsements	Expiration

Driving Experience

Class of Equipment	Type (Van, Tank, Flat, etc.)	Date From	Date To	Approx Miles
Straight Truck
Tractor & Semi
Tractor & 2 Trailers
Tractor & Tanker
Other

Accident Record — Past 3 Years

None to report Attach additional sheet if needed

Date	Nature of Accident	# Fatalities	# Injuries	Chemical Spill?

Traffic Convictions & Forfeitures — Past 3 Years (No Parking)

None to report

Date Convicted	Violation	State	Penalty (Bond, Collateral, Points)

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

YES NO

If yes, explain

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

YES NO

If yes, explain

Employment History — Current / Most Recent

Employer Name

Phone

Address (Street, City, State, Zip)

Position Held

From (MM/YY)

To (MM/YY)

Salary

Reason for Leaving

Explain Any Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations while employed here?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 (drug/alcohol) testing?

YES NO

Employment History — Second Most Recent

Employer Name

Phone

Address

Position Held

From

To

Salary

Reason for Leaving

Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 testing?

YES NO

Employment History — Third Most Recent

Employer Name

Phone

Address

Position Held

From

To

Salary

Reason for Leaving

Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 testing?

YES NO

Education

Level	School Name & Location	Course of Study	Years Completed	Graduate?
High School
College
Other

Other Qualifications

List any other qualifications you believe should be considered

Authorization & Certification

I authorize Nightfall Express LLC to make investigations (including contacting current and prior employers) into my personal, employment, financial, and medical history as may be necessary in arriving at an employment decision. I release all persons from liability in responding to inquiries in connection with my application.

I understand that false or misleading information given in my application may result in discharge. I understand my information may be used to investigate my safety performance history as required by 49 CFR 391.23, and that I have the right to review, correct, or rebut any information provided by prior employers.

By submitting this application, I certify that all entries are true and complete to the best of my knowledge.

I have read and agree to the above authorization. I certify that all information provided is accurate and complete. *

Full Legal Name

Driver Employment Application