Michael Test

Recruiter Name

Prospective Employer

First Name

Middle Name

Last Name

Phone

Email

Position Applied for

Social Security # (optional, last 4 is fine)

_

Date of birth

Date of Application

Date Available for Work

Do you have legal right to work in the United States?

Yes

No

How Long have you driven a Class 8 Tractor Trailer

How is your MVR(Motor Vehicle Record)

Have you ever failed a drug test or failed to take one ?

Medical Card

Do you have any felonies in your background?

Do you have a military background?

What do you think about your last employer?

How old are you?

Communication Style

Understanding Job Description

Did the Applicant receive an application and expected timeline?

Recruiter Notes and Driver Overview

MC#

DotNo

Authority Stability

Background

Financial Stability

Insurance

MVR

Number of Trucks

Oilfield Experience

Personality

Physical Condition

PSP

SAP

Sex Offender

SMS

Stability

Team

Truck Condition

Work Smartphone Apps

Behavior

Yes No

Respect is mandatory.Disrespecting is grounds for disciplinary action and or termination. Temper or other poor behavior is not tolerated.

Yes No

Please acknowledge that some patience is required.For example, our customers may stop a well for repairs for a day or two.

Yes No

Doing what you say when you say you are going to do it is the professional behavior we expect.

Yes No

Safe communication is required.

Experience

Years of driving reefer or dry van

Years of experience driving flatbed

Years of experience in agricultural

Years of experience in oilfield work

Describe Experience

MVR

Medical Card

Drugs

Tractor(s)

Tractor

Miscellaneous

Yes No

Broker Packet Attached

Yes No

A rated Insurance company(or higher) and insurance payments are current.

Yes No

Any non-reported accidents or problems like a parking lot fender bender or unreported load shifts with damage.

Street Address

City

State

Zip Code

# of Years at Address

What type of address is this ?

Current

Mailing

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years.

State

License #

Type/Class

Issue Date

Expiration Date

Endorsement

What type of license is this ?

Current

According to the Federal Motor Carrier Safety Administration (FMCSA) regulations specifically 49 CFR 391.41-49, commercial drivers are required to be physically qualified to drive a CMV, and one of the ways this is demonstrated is through obtaining a medical examiner's certificate.

Medical Examiner Name

Issuing State

Medical Examiner's state License. Certificate, or Registration Number

National Registry Number

Date Certificate Signed

Medical Examiner's Certificate Expiration Date

Conditions and notes

State

License Plate

Type/Class

Vehilcle Identification Number

Expiration Date

Endorsement

Apportioned Tag?

Yes

No

Under 49 CFR 391.11(b)(2), a driver must be able "to operate the type of commercial motor vehicle he/she drives.

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Approx # of Miles (Total)

Date from

Date to

49 CFR 391.23 requires motor carriers to make inquiries into a driver's driving record and safety performance history.

Date

Nature of Accident (Head-on, rear-end, upset, etc.)

# Fatalities

# Injuries

Chemical Spills ?

yes

No

49 CFR 391.23 requires motor carriers to make inquiries into a driver's driving record and safety performance history.

Date Convicted

Violation

Violation State

Penalty (Forfeited bond, collateral and/or points)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? If yes explain

yes

No

Explanation (only if yes)

Has any license, permit, or privilege ever been suspended or revoked? If yes explain

yes

No

Explanation (only if yes)

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. end with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

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Name

City

If the search does not find Employer's Name, please enter below.

Subject to FMCSA:

Yes

No

Address

Phone

Email

DOT Number or Customer ID

Position Held

From

To

Reason for Leaving

Salary

Explain any gaps in Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

yes

No

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Name

City

If the search does not find Employer's Name, please enter below.

Subject to FMCSA:

Yes

No

Address

Phone

Email

DOT Number or Customer ID

Position Held

From

To

Reason for Leaving

Salary

Explain any gaps in Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

yes

No

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Name

City

If the search does not find Employer's Name, please enter below.

Subject to FMCSA:

Yes

No

Address

Phone

Email

DOT Number or Customer ID

Position Held

From

To

Reason for Leaving

Salary

Explain any gaps in Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

yes

No

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Name

City

If the search does not find Employer's Name, please enter below.

Subject to FMCSA:

Yes

No

Address

Phone

Email

DOT Number or Customer ID

Position Held

From

To

Reason for Leaving

Salary

Explain any gaps in Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

yes

No

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Name

City

If the search does not find Employer's Name, please enter below.

Subject to FMCSA:

Yes

No

Address

Phone

Email

DOT Number or Customer ID

Position Held

From

To

Reason for Leaving

Salary

Explain any gaps in Employment (Include month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

yes

No

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?

yes

No

School

Name & Location

Course of Study

Years Completed

Graduated ?

yes

No

Details

Please list any other qualifications that you have and which you believe should be considered.

Under 49 CFR 391.21(b)(11) an application for employment must be signed by the applicant certifying that all the information provided is true and complete.

Applicant Signature

Applicant Name

Date

Current Signature

Signature Date:

11-02-2026

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Michael Test

Baseline

Behavior

Experience

Tractor(s)

Miscellaneous

11-02-2026

Email activity

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Michael Test

Interview Questions

Baseline

Behavior

Experience

Tractor(s)

Miscellaneous

Previous Three Years Residency Company Addresses

License Information

Medical Card Information

Equipment Information

Driving Experience

Accident Record for the Past 3 Years

Traffic Convictions and Forfeitures for the Past 3 Years (Other then Parking Violations)

Employment History Trade References

Education

Other Qualification

To be Read and Signed by Applicant

11-02-2026

Documents

Email activity