49 C.F.R. § 391.21
(b)
The application for employment shall be made on a form furnished by the motor carrier. Each application form must be completed by the applicant, must be signed by him/her, and must contain the following information:
(1)
The name and address of the employing motor carrier;
(2)
The applicant's name, address, date of birth, and social security number;
(3)
The addresses at which the applicant has resided during the 3 years preceding the date on which the application is submitted;
(4)
The date on which the application is submitted;
(5)
The issuing driver's licensing authority, number, and expiration date of each unexpired commercial motor vehicle operator's license or permit that has been issued to the applicant;
(6)
The nature and extent of the applicant's experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semitrailers, full trailers, and pole trailers) which he/she has operated;
(7)
A list of all motor vehicle accidents in which the applicant was involved during the 3 years preceding the date the application is submitted, specifying the date and nature of each accident and any fatalities or personal injuries it caused;
(8)
A list of all violations of motor vehicle laws or ordinances (other than violations involving only parking) of which the applicant was convicted or forfeited bond or collateral during the 3 years preceding the date the application is submitted;
(9)
A statement setting forth in detail the facts and circumstances of any denial, revocation, or suspension of any license, permit, or privilege to operate a motor vehicle that has been issued to the applicant, or a statement that no such denial, revocation, or suspension has occurred;
(10)
(i)
A list of the names and addresses of the applicant's employers during the 3 years preceding the date the application is submitted,
(ii)
The dates he or she was employed by that employer,
(iii)
The reason for leaving the employ of that employer,
(iv)
After October 29, 2004, whether the (A) Applicant was subject to the FMCSRs while employed by that previous employer,
(B)
Job was designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by
49 CFR part 40;
(11)
For those drivers applying to operate a commercial motor vehicle as defined by
part 383 of this subchapter, a list of the names and addresses of the applicant's employers during the 7-year period preceding the 3 years contained in
paragraph (b)(10) of this section for which the applicant was an operator of a commercial motor vehicle, together with the dates of employment and the reasons for leaving such employment; and
(12)
The following certification and signature line, which must appear at the end of the application form and be signed by the applicant:
Notes, amendments, and revision history
Amendments
[35 FR 6460, Apr. 22, 1970, as amended at 35 FR 17420, Nov. 13, 1970; 52 FR 20589, June 1, 1987; 60 FR 38744, July 28, 1995; 69 FR 16719, Mar. 30, 2004; 87 FR 13208, Mar. 9, 2022]
Authority
Authority: 49 U.S.C. 504, 508, 31133, 31136, 31149, 31502; sec. 4007(b), Pub. L. 102-240, 105 Stat. 1914, 2152; sec. 114, Pub. L. 103-311, 108 Stat. 1673, 1677; sec. 215, Pub. L. 106-159, 113 Stat. 1748, 1767; sec. 32934, Pub. L. 112-141, 126 Stat. 405, 830; secs. 5403 and 5524, Pub. L. 114-94, 129 Stat. 1312, 1548, 1560; sec. 2, Pub. L. 115-105, 131 Stat. 2263; and 49 CFR 1.87.
Source
Source: 35 FR 6460, Apr. 22, 1970, unless otherwise noted.
Amendments
[35 FR 6460, Apr. 22, 1970, as amended at 35 FR 17420, Nov. 13, 1970; 52 FR 20589, June 1, 1987; 60 FR 38744, July 28, 1995; 69 FR 16719, Mar. 30, 2004; 87 FR 13208, Mar. 9, 2022]