Applicant to Complete

List your addresses of residency for the past 3 years


Only Complete the next section if you are applying for a driving position, otherwise skip to Employment History.

Date Nature of Accident Towed away? Fatalities? Injuries? Hazmat Spill?
Last Accident
Next Previous
Next Previous
Location Date Charge Penalty
State of issuance License number Type Expiration/forfeiture date
Driving Experience
Class of Equipment (Type or Write in All That Apply)
28' 40' 48' 53' Van, Refer, Dump, Tank. Flat. Dry Bulk. Rail Con
Number Miles
Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 10 years.

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicles on a highway in interstate commerce to transport passengers or property when the vehicle: (1) a GVWR of 10,001 lbs. or more. (2) is designed or used to transport more than 8 passengers (including the driver), or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.


 I understand that as required by the Federal Motor Carrier Safety Regulations, Section 391.103, and Todd Transit Company policy, all prospective drivers must submit to a controlled substances test.

A urine sample will be collected and tested for controlled substances.
I also understand that if I test positive for use of controlled substances, I am not medically qualified to operate a commercial motor vehicle.

The results of the controlled substances test will be maintained by the Medical Review Officer for the company who will report whether the test results were negative or positive, and if positive, the identity of the controlled substance for which the test was positive. The results will not be released to any additional parties without my written authorization.
I hereby agree to submit to a drug screen urinalysis.


 It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

 It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

 I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

 It is agreed and understood that this application for qualification in no way obligates the motor carrier to employ the applicant.

 It is agreed and understood that if qualified, I may be on a probationary period during which time I may be disqualified without recourse.

 It is agreed and understood that any misrepresentation given on this "application for employment" shall be considered an act of dishonesty. I further certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

 It is agreed and understood that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.


Clicking submit assumes that you give your consent for this data to be shared with the HR department of and that all the information is correct.

Any reference to Separate Sheet, please explain in the Other Details box.