Personal Information:
Date: (xx/xx/xxxx)
Name: Social Security #:
Date of Birth: Phone #:
Address:
City: State: Zip:
Email Address:
Recommended By:
Current Drivers License #: State: Exp. Date:
Previous Drivers License #: State:
Number of Citations: Number of Accidents:
Do you have any felony convictions?
Do you have any license suspensions?
Name of driving school:
Present or last employer:
Name: Phone:
Address:
City: State: Zip:
Number of states: Employed from: To:
Reason for leaving:
Previous Employer:
Name: Phone #:
Address:
City: State: Zip:
Number of states: Employed From: To:
Reason for leaving:
Previous Employer:
Name: Phone #:
Address:
City: State: Zip:
Number of states: Employed From: To:
Reason for leaving:
As part of our consideration of your application, the DOT requires us to investigate your employment background. As part of this investigation, we may obtain consumer reports about you from DAC Services. DAC is a consumer reporting agency. Any decision we make not to hire you based on information contained in your consumer report will be our decision alone. DAC does not make any decisions concerning your employment with us and will not know the specific reasons why we may decide not to hire you. In the event you are not hired based on information contained in your consumer report, we will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report. Consent for us to obtain the report from DAC is required. Although you have a right to withhold your consent, we may not consider your application if you do. By submitting this application you give us permission to obtain consumer reports about you from DAC.