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The information requested on this form is required by federal law (49 CFR) to be provided by any applicant applying for a commercial motor vehicle (CMV) position as defined by 49 CFR 390.5. Failure to complete the required areas can place both the applicant and carrier in violation of federal law. Information provided will be verified by carrier as required under various parts of 49 CFR, including Part 382 and Part 391. If help is required to complete form please ask an authorized PB Materials representative.
PLEASE PRINT CLEARLY, FILL OUT EACH AREA OUTLINED IN A GREEN BOX, AND SIGN YOUR FULL LEGAL NAME AT THE
END WHERE REQUIRED. ANY INFORMATION NOT COMPLETED IN AREAS HIGHLIGHTED BY THE GREEN BOX MAY RESULT IN THE APPLICATION NOT BEING PROCESSED FALSE STATEMENTS MAY RESULT IN REFUSAL TO HIRE OR IMMEDIATE TERMINATION
The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle provide employment history 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.
FAILURE TO COMPLETE REQUIRED YEARS OF EMPLOYMENT HISTORY WILL ELIMINATE THE APPLICANT FROM BEING CONSIDERED FOR EMPLOYMENT.
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