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Driver Experience and Qualifications
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State License Number Type Expiration Date
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____________________________________________________________________________________
____________________________________________________________________________________
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A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
B. Has any license, permit, or privilege ever been suspended or revoked?
If the answer to either "A" or "B" is yes, attach a statement giving details.
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Yes _____ No _____
Yes _____ No _____
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Class of Equipment Type of Equipment Dates Approximate No. of Miles
(Van, Tank, Flat, etc.) From To (Total)
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_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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Straight Truck
Tractor and Semi-Trailer
Tractor--Two Trailers
Other
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List States operated in for last five years
Show special courses that will help you as a driver.
Which Safe Driving Awards do you hold
and from whom?
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_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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Accident Record (Attach sheet if more space is needed)
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Dates Nature of Accident Fatalities Injuries
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Last Accident
Next Previous
Next Previous
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__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Traffic Convictions and Forfeitures For The Past 3 Years (other than parking violations)
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Location Date Charge Penalty
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_________________________________________________________________________________________________
_________________________________________________________________________________________________
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This certifies that this application was completed by me, and that all entries on it and the information in it are true and complete to the best of my knowledge.
It is agreed and understood: Wiest Truck Line, Inc. and/or its agents may investigate my background and contact prior employers for information required by the Federal Motor Carriers Safety Regulations. Any misrepresentation of information provided by me shall be considered an act of dishonesty, and the application process may be terminated. At the time an employment is terminated between Wiest Truck Line, Inc. and an employee, any monies or liabilities incurred by the employee become due immediately and in full to the Company. I hereby release previous employers or other persons from all liability and /or damages in furnishing requested information about me.
Applicant's Signature ________________________________________________ Date ________________________________
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