You are filling out the CDL application. Required fields are marked with *.
Information on this application complies with U.S. Department of Transportation regulation 49 CFR 391.21. Qualified applicants are considered for all positions without regard to race, religion, sex, sexual orientation, national origin, age, marital status, or non-job related disability.
Where this application asks for a signature, sign in the box with your finger, a stylus, or your mouse. We collect the last four digits of your Social Security number now so we can check your driving record before your interview. We collect your full Social Security number and any remaining paperwork in person.
Former employers List the last four employers, starting with the most recent. Driver applicants in interstate commerce must list all employers during the preceding 3 years. Applicants who drove a commercial motor vehicle in intrastate or interstate commerce must also list an additional 7 years for employers where they operated that vehicle. Add employers until that history is covered, up to 12.
Add employer Remove last employer
Accident record for the past 3 years or more Leave the table blank if you have had no accidents.
Add accident Remove last accident
Truck / tractor experience Personal references Give the names of three persons not related to you.
Notices Equal employment opportunity It will continue to be the policy of Northeastern Pavers not to discriminate against any applicant for employment, or any employee, because of race, religion, sex, color, national origin, age, or handicap. Applicants and employees are hired, compensated, trained, advanced, demoted, transferred, and terminated on the basis of skill, devotion and loyalty, honesty, reliability, and integrity.
Notice to applicant This employer complies with the Americans with Disabilities Act of 1990. During the interview process you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination. All information will be kept confidential and in separate files.
Applicants accepted for employment should understand that while we make an effort to provide steady, continuous work, we have no employment contracts and we cannot guarantee the permanence of any position. Job tenure can be affected by business and economic conditions, changes in laws or employer policies, conformity to our work rules, job performance, and employees may leave of their own accord.
We conduct our business with the highest possible degree of safety and efficiency. Because of this, the employer may require applicants to undergo blood and/or urinalysis screening for drug or alcohol use as part of our pre-placement physical examination. All employees are subject to random blood tests and/or urinalysis screening for drug or alcohol use.
DOT drug and alcohol history check Applicant authorization to release DOT drug/alcohol test results (as required by 49 CFR Parts 40.25 and 391.23) I, as the “Applicant,” understand that as a condition of hire with Northeastern Pavers companies, I must consent to the release of all DOT mandated drug and alcohol information from all of the employers for which I worked in a DOT safety-sensitive position, or for which I took a DOT pre-employment drug test, during the previous two (2) years as required by DOT Part 40.25, or three (3) years as required by Part 391.23 for any driver of a commercial motor vehicle. I have listed in the former employers section above all of the employers for which I have worked during the past two years (or three years as a CDL driver). I hereby authorize all of my previous employers listed there to furnish to Northeastern Pavers companies the DOT information described below.
Applicant certification: I have read and fully understand this authorization to release my previous drug and alcohol test information, identified by the check boxes below, to Northeastern Pavers companies. In signing below, I certify that all of the information I have furnished on this form is true and complete, and that I have identified all of the employers for which I have worked in a DOT safety-sensitive position during the previous two years (or three years as a CDL driver). I also understand that I am responsible for all costs associated with any pending Substance Abuse Professional assessment recommendations, education and treatment, including costs involving return-to-duty testing and follow-up testing yet to be completed.
Check this box if you have not performed DOT functions in the past two years (or three years as a CDL driver). Check this box if you have tested positive, or refused to test, on any DOT pre-employment drug or alcohol test for an employer who did not hire you during the past two years (or three years as a CDL driver). Driver's signature *
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By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
Safety performance history records request This request is made by the driver/applicant in compliance with the Department of Transportation regulations. To: each previous employer you listed in the former employers section above. From: you (your name and contact details are in the information above).
I am submitting this written request to release and forward the information requested concerning my alcohol and controlled substances testing records within the previous 3 years from the date entered below. In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures confidentiality, such as fax, email or letter.
Testing records for the previous 3 years from
The information must be provided to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business day deadline will begin when the prospective employer receives the requested safety performance history information.
Applicant's signature *
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By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
Record of violations I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.
If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.
Driver's signature *
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By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
Certification of compliance with driver's license requirements 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 placards.
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 placards.
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 1, 1987. They are as follows:
Possess only one license: you, as a commercial vehicle driver, may not possess more than one motor vehicle operator's license. If you have more than one license, 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. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state.
Notification of license suspension, revocation or cancellation: Sections 391.5(b)(2) and 383.33 of the Federal Motor Carrier Safety Regulations required 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 within 30 days to your employing motor carrier, and the state that issued your license (if the violation occurs in a state other than the one which issued your license). The notification to both the employer and state must be in writing.
The following license is the only one I will possess.
Driver's license number * State * Expiration date *
Driver certification: I certify that I have read and understood the above requirements.
Applicant's signature *
× Sign here with your finger, a stylus, or your mouse Undo Clear Type my name instead
By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
Texas DPS release of reported test results Release of CDL holder's reported positive alcohol or controlled substance test results (Texas DPS form MCS-21) This release is used to obtain the CDL holder's reported positive alcohol or controlled substance test results information. It should only be used to inquire whether or not a prospective driver (CDL holder) has had a positive alcohol or controlled substance test result reported to the Texas Department of Public Safety in compliance with state law.
I authorize release of the CDL holder's reported positive alcohol or controlled substance test results reported under state law to Northeastern Transportation LLC, 5750 Weatherford Hwy, Granbury, TX 76048, (817) 573-3809.
Check here if the CDL holder is requesting results on self. Driver's signature *
× Sign here with your finger, a stylus, or your mouse Undo Clear Type my name instead
By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
FMCSA Drug and Alcohol Clearinghouse consent General consent for limited queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse I, the applicant named above , hereby provide consent to Northeastern Pavers LLC and Northeastern Transportation LLC to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I am consenting to multiple queries by Northeastern Transportation for the duration of my employment.
I understand that if the limited query conducted by Northeastern Pavers LLC and Northeastern Transportation LLC indicates that drug or alcohol violation information exists in the Clearinghouse, FMCSA will not disclose that information to Northeastern Pavers LLC or Northeastern Transportation LLC without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for Northeastern Pavers LLC and Northeastern Transportation LLC to conduct a limited query of the Clearinghouse, Northeastern Pavers LLC and Northeastern Transportation must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
Employee signature *
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By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
Permission to request driver safety records This lets us request your driving record (MVR) before your interview. Your name, address, CDL number, and date of birth come from the information above.
Fair Credit Reporting Act disclosure 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 II, 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. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.
Permission I understand that as a normal part of the hiring process the driving records of all prospective employees are reviewed. In addition, I understand that my driving record is subject to future periodic reviews.
I hereby authorize Northeastern Pavers/Northeastern Transportation, Inc. and its insurance agent to secure my Driver Safety Records both now and in the future for determining insurability under the Corporate Automobile Insurance Coverage, said employer is making application for and/or determining driver safety or other use permissible under the provisions of the Driver's Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Section 300002(a)). You are released from any and all liability that may result from furnishing such information.
Last four digits of your Social Security number *
Applicant's signature *
× Sign here with your finger, a stylus, or your mouse Undo Clear Type my name instead
By signing here, I agree that my electronic signature, drawn or typed, has the same effect as my handwritten signature. It is dated when I submit this application.
I certify that the information on this CDL application is true and complete. I understand that false information may disqualify me from employment with Northeastern Pavers.
