Driver Application Driver Application *Note – ALL fields are required. Applying for* Company Driver Owner Operator Name* First Last Phone*Date of Birth* Month Day Year Social Security #*(format: xxx-xx-xxxx)Email* Cell Phone*Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long*List all addresses other than the current address that you have resided in during the past 3 years, and how long you lived there:Previous Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How LongPrevious Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How LongPrevious Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How LongHave you ever worked for Hanke Trucking, Inc. before?* Yes No When?Why did you leave?Who referred you to Hanke Trucking, Inc. or what publication did you see our ad in?*License InformationHas your license, permit or privilege to operate a motor vehicle ever been denied, revoked or suspended?* Yes No IF Yes, please explainShow the exact name as shown on your current CDL*List all drivers licenses held in the past 3 yearsState*License Number*Class/Type*Endorsements/Restrictions*Exp. Date*State*License Number*Class/Type*Endorsements/Restrictions*Exp. Date*State*License Number*Class/Type*Endorsements/Restrictions*Exp. Date*Driving InformationDriving Experience Check YES or NO for each type of vehicle shown below. Show the approximate month/year you began driving that class CMV and the month/year you last drove that class. Show the approximate total career miles you have driven for each class.STRAIGHT TRUCK* Yes No TYPE OF TRAILERVanTruckFlatDumpReferFROM (M/Y)TO (M/Y)APPROX # OF MILESTRACTOR & SEMI TRAILER* Yes No TYPE OF TRAILERVanTruckFlatDumpReferFROM (M/Y)TO (M/Y)APPROX # OF MILESTRACTOR & 2 TRAILERS* Yes No TYPE OF TRAILERVanTruckFlatDumpReferFROM (M/Y)TO (M/Y)APPROX # OF MILESBUS/MOTOR COACH* Yes No # of PassengersFROM (M/Y)TO (M/Y)APPROX # OF MILESOTHER TYPE CMV* Yes No ExplainFROM (M/Y)TO (M/Y)APPROX # OF MILESList all accidents you have been involved in during the past 3 years, regardless of severity, fault or type of vehicle driven.IF NO ACCIDENTS, CHECK BOX BELOW* I have not been involved in a accident in the past 3 years. Date Month Day Year LOCATION (CITY/STATE)TYPE ACCIDENT# INJURED# FATALITIESTYPE VEHICLE DRIVENEMPLOYMENT RELATED Yes No Date Month Day Year LOCATION (CITY/STATE)TYPE ACCIDENT# INJURED# FATALITIESTYPE VEHICLE DRIVENEMPLOYMENT RELATED Yes No Date Month Day Year LOCATION (CITY/STATE)TYPE ACCIDENT# INJURED# FATALITIESTYPE VEHICLE DRIVENEMPLOYMENT RELATED Yes No List all traffic violations for which you have been convicted, forfeited bond or collateral during the past 3 years (other than parking). IF NO VIOLATIONS, CHECK BOX BELOW* I have not been been convicted, forfeited bond or collateral due to traffic violations in the past 3 years. Date Month Day Year STATEVIOLATIONPENALTYTYPE VEHICLEDate Month Day Year STATEVIOLATIONPENALTYTYPE VEHICLEDate Month Day Year STATEVIOLATIONPENALTYTYPE VEHICLEIf you graduated from Truck Driving School please indicate the name of the school, City/State and year of graduation*Employment HistoryList all employment during the past 3 years, beginning with your present or most recent position. If you worked for a fleet operator or you were an owner operator, show the company you had the vehicle leased to or were qualified to drive for. In addition, you must show all positions you were qualified to drive a commercial motor vehicle for the past 10 years. Please be sure to list all information including the reason for leaving.Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No Employer NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonPhoneTo (M/Y)From (M/Y)Position HeldSalary/WageReason for leavingWere you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol test requirements of 49 CFR 40? Yes No BE SURE THAT YOU HAVE LISTED ALL EMPLOYMENT FOR THE PAST 3 YEARS AND DRIVING JOBS FOR THE PAST 10 YEARS!Click here to download Release Forms. FAX your release forms to 262-644-8342.In accordance with 49 CFR part 391.21(b) 10 and 391.21(d), the following information is being provided to you prior to the completion and/or acceptance of an application for driver qualification. This includes a Summary of Your Rights under the Fair Credit Reporting Act - PRINT OR SAVE FOR YOUR RECORDSI CERTIFY THAT...* THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. CommentsThis field is for validation purposes and should be left unchanged.
