The TESS Company - Transfilling & Hydro testing

Street Address

Zip Code

First Occupied
mm/dd/yyyy

Last Occupied
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EMPLOYMENT CDL APPLICATION
An Equal Opportunity Employer

CDL SUPPLEMENTAL INFORMATION SHEET (As required by 49 CFR Subpart C (391.21)

CDL DRIVER APPLICATION FORM GENERATED BY: THE TESSCOMPANY 896 N. WATER ST. SUITE F GALLATIN, TN 37066 615 230-2050

DRIVERS PERSONAL INFORMATION (As required by 49 CFR Subpart C (391.21 (B(1,2,4,5))))

Last Name: First Name: Middle Initial: Date:

Current CDL License #: State: Exp. Date: License Class:

Endorsements: Date of Birth: Phone:

DRIVERS LIST OF RESIDENCES FOR PAST 3 YEARS (NO PO BOX) List current first, continuing in order to oldest last.
(As required by 49 CFR Subpart C (391.21 (b(3))))

DRIVERS LIST OF ACCIDENTS HE/SHE WAS INVOLVED IN FOR THE PAST THREE YEARS Most Recent First
(As required by 49 CFR Subpart C (391.21 (7)))

At Fault	Fatalities	Injuries	Property Damage
Yes No	Yes No	Yes No	Yes No
Yes No	Yes No	Yes No	Yes No
Yes No	Yes No	Yes No	Yes No
Yes No	Yes No	Yes No	Yes No

DRIVERS LIST OF TRAFFIC VIOLATIONS HE/SHE WAS CONVICTED, FORFEITED BOND or COLLATERAL
(As required by 49 CFR Subpart C (391.21 (8)))

Date	Violation Description	City/State of Violation	Driving Conditions	Type of Vehicle

* Do NOT include Parking citations in the above table

DRIVERS LIST OF PREVIOUS EMPLOYERS in which you operated a CMV in past 10 years
(As required by 49 CFR Subpart C (391.21 (10 & 11)) & (383.35(C)) Most Current first, continuing in order to the oldest

Previous Employer Name	City, State, Zip	Phone Number (xxx) xxx-xxxx	Start Date	End Date	Reason For Leaving

DRIVERS EXPERIENCE IN OPERATION OF COMMERCIAL MOTOR VEHICLES (As required by 49 CFR Subpart C (391.21 (6)))

* Include vehicles such as buses, trucks, truck trailers, Semi-trailers, Full Trailers, and pole trailers.

Type of Vehicle	Length of Experience	Formal Training Received	Vehicle Used Locally	Vehicle Used Regionally/Nationally	How Well Did You Like Driving It

DRIVERS ACKNOWLEDGEMENT AND CERTIFICATION STATEMENT (As required by 49 CFR Subpart C (391.21 (12) & 391.23 (d)(e) & 391.21 (i)))

I certify that this application was completed by me, and that all entries on it are true and complete to the best of my knowledge. I
understand that The TESS Co. will use above collected information to conduct background check as required by regulations
governed by the Federal Motor Carrier Safety Administration. I understand that this is a safety sensitive position and substance
abuse testing will be done randomly and before hire as per USDOT requirements. I understand that The TESS Company is a Drug
Free Workplace and agree to follow the rules of the program.

Date: Applicant Signature: