Previous Address(es) during last 3 years (FMCSR 391.21 (3))*
Date of Birth (required by FMCSR 391.21 (2) to verify motor vehicle report)*
Please read carefully
Employment record for past 10 years
DOT Regulations require: START YOUR MOST RECENT JOB.
If your driving experience is less than 3 years, than write down all your work experience for the past 3 years.
If your driving experience is more than 3 years but less than 10 years, then write all of your driving experience.
No need to write down any driving experience that is over 10 years.
Reglamento del DOT: INICIE CON SU TRABAJO MÁS RECIENTE Y ANOTE PROGRESIVAMENTE
Si su experiencia de manejo es más de 3 años pero menos de 10 años, enliste toda su experiencia de manejo.
No necesita anotar experiencia de trabajo mayor a 10 años.
IF YOU HAVE BEEN UNEMPLOYED FOR SOME TIME, PLEASE INDICATE DATES AND REASON BELOW
Explain the reason for gap in employment
(1) Current or most recent employer
Gap in employment between job (1) and (2)
Second most recent employer
Gap in employment between job (2) and (3)
Third most recent employer
Gap in employment between job (3) and (4)*
Tractor & trailer
Tractor & reefer
Aproximate number of miles
Moving traffic convictions list for past five (5) years. If none write none.
States in which you hace operated a class-A motor vehicle in the past five years:
Please list 2 people able to verify your employment and personal history. Such as co worker, neighbor, customer or an upstanding citizen of your community. **DO NOT LIST RELATIVES**