GT 1-01-01

Driver Application Form Heavy Haul

  • Personal Information

  • Addresses

    Addresses you have resided in the last three (3) years.
  • Driving Experience

    49 CFR 391.21(b)(6) Provide a single statement regarding the nature and extent of your experience in the operation of motor vehicles, including the type of equipment (buses, trucks, truck tractors, semitrailers, full trailers, and pole trailers) which you have operated.
  • Accident Review

    For Last 3 Years - Including Private Vehicles 49 CFR 391.21(b)(7) List all motor vehicle accidents in which you were involved during the 3 years preceding the date the Driver Qualification form was submitted, specifying the date and nature of each accident and any Fatalities or Personal Injuries it caused.
  • Traffic Convictions and/or Forfeitures

    For Last 3 years - Including Private Vehicles. 49 CFR A 391.21(b)(8) List all violations of motor vehicle laws or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the 3 years preceding the date of the Driver Qualification Form was submitted.
  • Previous Employment Record

    49 CFR 391.21(b)(10) and (b)(11) Provide the requested information for ALL employers for the past three years. You must also list any employers for which you operated a commercial motot vehicle in the past 10 years.
  • General Information

  • License Information

    49 CFR 391.21(b)(5) List all unexpired commercial motor vehicle operator's licenses currently held. *Use numbers and letters only. No dashes, spaces, or other symbols.
  • Endorsements

  • License Suspensions, Revocations & Denials

    49 CFR 391.21(b)(9)
  • Drop files here or
    Accepted file types: doc, pdf, .
    Washington State driver applicants are required to attach MUR.
  • To be Read and Signed by Driver Applicant

    This certifies that this Driver Qualification From was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. 49 CFR 391.21(b)(12). I understand and agree that drug and alcohol testing will be performed in accordance with 49 CFR part 40 and any additional testing as required by the Company.) I authorize the release of any controlled substance and/or alcohol test result in response to any inquiry regarding my work history with Gresham Transfer. I understand that it is Gresham Transfer's policy to maintain practices, which prevent discrimination against my person on the basis of race, creed, sex, religion, national origin, or any other protected classification. I understand and agree that this Driver Qualification Form and other related documents will be retained for no longer than 30 days from the date of submission. At the conclusion of that time, if I have not been qualified by Gresham Transfer and I still wish to be considered for qualification, it will be necessary for me to complete another Driver Qualification Form. I understand and agree that any misrepresentation of information shall be considered an act of dishonesty and grounds for non-consideration. I understand and agree that this form does not obligate Gresham Transfer in any way. I understand that the information in this qualification form will be used for qualification purposes and that prior employers may be contacted for the purpose of investigation as required by 49 CFR 391.23. I understand and agree that this form must be signed by me in order to commence with the qualification process with Gresham Transfer. I understand the typing of my name below authorizes as an electronic signature. Facsimile and electronic signatures shall be considered original signatures.
contact us 1-33