DRAFT for review. Yellow CONFIRM tags mark details to confirm with the owner. Set DRAFT_MODE=false to hide them.

Driver application

About 10 minutes. Have your CDL, DOT medical card, and your last 3 years of jobs ready. Your answers save on this device as you go.

1 Position & contact info

Position you're applying for

First name Middle Last name

Mobile phone Email (optional)

It's OK to text me about my application. Message & data rates may apply. Street address

City State ZIP

Years at this address Date of birth

Previous addresses, past 3 years (if less than 3 years at current)

Earliest start date Best time to call

Preferred language How did you hear about us?

Are you legally eligible to work in the United States? No Yes

4 Employment history

List every employer for the past 3 years, most recent first, including non-driving jobs. If you drove a commercial vehicle for anyone in the past 10 years, list those employers too (49 CFR 391.21).

Employer 1

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 2

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 3

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 4

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 5

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 6

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 7

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 8

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 9

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Employer 10

Company name City, state

Phone Position held

From (month/year) To (month/year, blank if current)

Reason for leaving

Were you subject to the FMCSRs (DOT regs)? Was the job a DOT drug/alcohol-tested (safety-sensitive) position?

Explain any gaps in employment over 30 days (optional) I have had no employment in the past 3 years.

5 Accidents & violations (past 3 years)

Accidents / crashes

None in the past 3 years

Accident 1

Date Nature (head-on, rear-end, backing, etc.)

Fatalities Injuries Hazmat spill?

Accident 2

Date Nature (head-on, rear-end, backing, etc.)

Fatalities Injuries Hazmat spill?

Accident 3

Date Nature (head-on, rear-end, backing, etc.)

Fatalities Injuries Hazmat spill?

Accident 4

Date Nature (head-on, rear-end, backing, etc.)

Fatalities Injuries Hazmat spill?

Accident 5

Date Nature (head-on, rear-end, backing, etc.)

Fatalities Injuries Hazmat spill?

Moving violations / convictions (other than parking)

None in the past 3 years

Violation 1

Date Location (city, state)

Charge Penalty

Violation 2

Date Location (city, state)

Charge Penalty

Violation 3

Date Location (city, state)

Charge Penalty

Violation 4

Date Location (city, state)

Charge Penalty

Violation 5

Date Location (city, state)

Charge Penalty

DOT drug & alcohol

In the past 2 years, have you tested positive, or refused to test, on a DOT pre-employment drug or alcohol test for a job you applied for but did not get? (49 CFR 40.25(j)) No Yes

If yes, have you completed the return-to-duty process?

6 Upload documents

Take a clear photo with your phone or upload a PDF. Max 10 MB each.

CDL (front) required CDL (back) optional DOT medical card required Other (MVR, certificates, etc.) optional

7 Background check disclosure

Disclosure regarding background investigation CONFIRM

Bahena Truckin LLC (the "Company") may obtain one or more consumer reports about you from a consumer reporting agency for employment purposes. These reports may include your motor vehicle record (MVR), criminal history, verification of previous employment, and other background information, as allowed by law. If you are hired or contracted, the Company may obtain additional reports during your employment or contract, as allowed by law.

The consumer reporting agency is: [Screening vendor name, address, phone, and website].

You can read A Summary of Your Rights Under the Fair Credit Reporting Act.

Authorization: I have read the disclosure above and I authorize Bahena Truckin LLC to obtain consumer reports about me for employment purposes.

8 Review & sign

A summary of your answers will appear here.

I understand that before driving, I must give electronic consent in the FMCSA Drug & Alcohol Clearinghouse for a pre-employment full query (49 CFR 382.701), and I consent to limited queries each year while employed. I'm willing to authorize an FMCSA Pre-Employment Screening Program (PSP) report. A separate PSP disclosure and authorization form will be provided. (optional) I certify that this application was completed by me and that all entries and information in it are true and complete to the best of my knowledge. I understand that false or missing information may disqualify me or lead to dismissal. I authorize Bahena Truckin LLC to contact my previous employers to investigate my safety performance history (49 CFR 391.23).

Type your full name as your signature Date

By typing your name you are signing this application electronically. How we protect your information.