CDL Drivers Please enable JavaScript in your browser to complete this form.Please complete this section only if you are applying for a position that requires you to hold a Commerical Drivers License. (this includes pick-up trucks pulling trailers, etc.) LICENSE INFORMATION Section 383.21 FMCSR states 'No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certiƶ' that I do not have more than one motor vehicle license the information for which is listed below. LayoutStateLicense No.TypeExpiration DateEXPERIENCELayoutClass of Equipment Straight Truck Tractor & Semi-Trailer Tractor-Two Trailers Other Type of Equipment - van, tank, flat, etc. Type of equipmentType of equipment Type of equipment Type of equipmentDates - From/To From/ToFrom/To From/To From/To Approzimate # of miles # miles# miles# miles # miles (copy)ACCIDENT RECORD FOR PAST 3 YEARS OR MORE Dates LayoutDate Date accident recordNature of Accident - head-on, rear-end, upset, etc. accidentaccident Number of Fatalities fatalitiesfatalitiesNumber of Injuries injuriesinjuries (copy)Chemical Spills spillsYesNospillsYesNoTRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS - OTHER THAN PARKING VIOLATIONSconvictionsDates Convicted - month/year Date Date Violation violationviolation State of Violation - Location state of violation state of violation PENALTY - forfeited bond, collateral and/or points penaltypenalty PER REQUIREMENTS OF FMCSA PART 391.21infoSocial Security NumberDate of BirthHave you ever been denied a license, permit or privilege to operate a motor vehicle?YesNoIf yes, explain:Has any license, permit, privilege ever been suspended or revoked?YesNoIf yes, explain:"l understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: Review information provided by current/previous employers Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected inforrnation 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." LayoutSignatureClear SignatureDateSubmit