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DOT Applicatione3admin2019-10-22T01:12:07-05:00
  • Application For Employment

  • Previous Three Years Residency

  • 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."
  • Straight Truck Experience

  • (van, tank, flat, etc.)
  • Tractor and Semi-trailer Experience

  • (van, tank, flat, etc.)
  • Tractor-Two Trailers Experience

  • (van, tank, flat, etc.)
  • Other Experience

  • (van, tank, flat, etc.)
  • Accident Record for Past Three Years or More

  • Accident 1

  • (head-on, rear-end, upset, etc.)
  • Accident 2

  • (head-on, rear-end, upset, etc.)
  • Accident 3

  • (head-on, rear-end, upset, etc.)
  • Traffic Convictions and Forfeitures

    Provide information for the past three years (other than parking violations)
  • Incident 1

  • (forfeited bond, collateral and/or points)
  • Incident 2

  • (forfeited bond, collateral and/or points)
  • Incident 3

  • (forfeited bond, collateral and/or points)
  • More Info

  • Employment Record

  • Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years.
  • Employer 1

  • Employer 2

  • Employer 3

  • Employment Gaps

  • Any gaps in employment and/or unemployment must be explained. Include dates and reason.
  • Employee Screening Release Form

  • Please download and complete the following release form. When instructed please fax to 1-844-325-0511.

    DISA Screening Release Form
  • To be read and signed by applicant

  • I authorize you to make sure investigations and inquires to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)

    I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

    In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

    “I 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 currently/previous employers;
    • Have errors in the information corrected by previous employers and for those previous employers to re-send the correct information 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.”

  • Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.
  • This field is for validation purposes and should be left unchanged.

CONTACT US


  • Corporate Location
    1004 Industrial Park Drive
    Clinton, MS 39056

  • info@E3Response.com
  • 601.460.1330
    24HR ER Hotline 1.844.333.0939

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