Oddson Underground Commercial Drivers License Application (CDL) Step 1 of 16 6% Personal DetailsName* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long?* Date of Birth* MM slash DD slash YYYY Social Security Number Phone Number*Cell Phone Number Name of First Emergency Contact* First Last First Emergency Contact Phone Number*Name of Second Emergency Contact* First Last Second Emergency Contact Phone Number* Three Previous Years of Residency***You do not need to fill this out if not applicable. Applicable Not Applicable Residency #1 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of YearsResidency #2 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of YearsResidency #3 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of Years License InformationType of ID*Drivers LicenseIdentification CardLicense or ID Number* State Issued to* Expiration Date* MM slash DD slash YYYY Driving Experience- Straight Truck (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approximate Number of Total Miles Driving Experience- Tractor, Two Trailers (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approximate Number of Total Miles Driving Experience- Tractor and Semi (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Approximate Number of Total MilesDate From MM slash DD slash YYYY Date To MM slash DD slash YYYY Other Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Approximate Number of Total MilesDate From MM slash DD slash YYYY Date To MM slash DD slash YYYY Accident Record For Past Three Years (Upload a file if more space is needed)Any?* Yes No Date MM slash DD slash YYYY Date MM slash DD slash YYYY Date MM slash DD slash YYYY Nature of Accident (Head- on, Rear- end, Upset, etc.) Number FatalitiesNumber of InjuriesChemical Spills? Yes No Upload File Here If NeededMax. file size: 100 MB. Traffic Convictions & Forfeitures For The Past Three Years (Other Than Parking Violations)Any?* Yes No Date MM slash DD slash YYYY Violation State of Violation Location Penalty (Forfeited Bond, Collateral and/or Points) Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes No Has any license, permit, or privilege ever been suspended or revoked?* Yes No If Yes, Explain**Please note that we will be running your drivers license prior to hiring to verify you have a valid drivers license and a clean driving record.** EducationName of High School Date Graduated MM slash DD slash YYYY Name of College (If Any) Date Graduated MM slash DD slash YYYY Employment RecordLast Employers Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number*Position Held Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Hourly Rate*Reasons For LeavingAny gaps in between employment and/or unemployment must be explained Yes No Date MM slash DD slash YYYY Date MM slash DD slash YYYY Date MM slash DD slash YYYY ReasonsWere you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer?* Yes No Was the previous job position designed as a safety sensitive function in any DOT regulated mode, subject to alcohol & controlled substance testing requirements by 49 CFR Part 40?* Yes No Second To Last Employers Name (not required if you've worked at your previous employer for over 5 years). Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone NumberPosition Held Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Hourly RateReasons For LeavingAny gaps in between employment and/or unemployment must be explained Yes No Date MM slash DD slash YYYY Date MM slash DD slash YYYY Date MM slash DD slash YYYY ReasonsWere you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer? Yes No Was the previous job position designed as a safety sensitive function in any DOT regulated mode, subject to alcohol & controlled substance testing requirements by 49 CFR Part 40?* Yes No Please note that Oddson Underground, Inc, reserves the right to contact previous employers to verify past employmentAre you an American Citizen?* Yes No Have you ever been convicted of, of pleaded no contest, to a felony within the last five years?* Yes No Have you ever been in the Armed Forces? Yes No If Yes, ExplainAre you currently a member of the Armed Forces? Yes No If Yes, please list your specialtyDate Entered MM slash DD slash YYYY By Submitting this I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if & after a condition offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/ or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391 .23(d) and (e). I understand that I have the right to: Review information provided by current/ previous employers, Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer, and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.By submitting this I certify that all of the information is true and complete to the best of my knowledge.Consent I agree to the privacy policy. Oddson Underground Commercial Drivers License Application (CDL) Step 1 of 17 5% Personal Details Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long?* Date of Birth* Date Format: MM slash DD slash YYYY Social Security Number Phone Number* Cell Phone Number Name of First Emergency Contact First Last First Emergency Contact Phone Number Name of Second Emergency Contact First Last Second Emergency Contact Phone Number Three Previous Years of Residency Residency #1 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of Years Residency #2 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of Years Residency #3 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of Years License Information Type of ID*Drivers LicenseIdentification Card License or ID Number* State Issued to* Expiration Date* Date Format: MM slash DD slash YYYY Driving Experience- Straight Truck (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Approximate Number of Total Miles Driving Experience- Tractor, Two Trailers (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Approximate Number of Total Miles Driving Experience- Tractor and Semi (If Applicable) Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Approximate Number of Total Miles Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Other Class of Equipment Type of Equipment (Van, Tank, Flat, etc.) Approximate Number of Total Miles Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Accident Record For Past Three Years (Upload a file if more space is needed) Any?* Yes No Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Nature of Accident (Head- on, Rear- end, Upset, etc.) Number Fatalities Number of Injuries Chemical Spills? Yes No Upload File Here If Needed Traffic Convictions & Forfeitures For The Past Three Years (Other Than Parking Violations) Any?* Yes No Date Date Format: MM slash DD slash YYYY Violation State of Violation Location Penalty (Forfeited Bond, Collateral and/or Points) Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes No Has any license, permit, or privilege ever been suspended or revoked?* Yes No If Yes, Explain **Please note that we will be running your drivers license prior to hiring to verify you have a valid drivers license and a clean driving record.** Education Name of High School Date Graduated Date Format: MM slash DD slash YYYY Name of College (If Any) Date Graduated Date Format: MM slash DD slash YYYY Employment Record Last Employers Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number* Position Held Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Salary Reasons For Leaving Any gaps in between employment and/or unemployment must be explained Yes No Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Reasons Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer?* Yes No Was the previous job position designed as a safety sensitive function in any DOT regulated mode, subject to alcohol & controlled substance testing requirements by 49 CFR Part 40?* Yes No Second To Last Employers Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number* Position Held Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Salary Reasons For Leaving Any gaps in between employment and/or unemployment must be explained Yes No Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Reasons Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer? Yes No Was the previous job position designed as a safety sensitive function in any DOT regulated mode, subject to alcohol & controlled substance testing requirements by 49 CFR Part 40?* Yes No Third To Last Employers Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number* Position Held Date From Date Format: MM slash DD slash YYYY Date To Date Format: MM slash DD slash YYYY Salary Reasons For Leaving Any gaps in between employment and/or unemployment must be explained Yes No Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Date Date Format: MM slash DD slash YYYY Reasons Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer? Yes No Was the previous job position designed as a safety sensitive function in any DOT regulated mode, subject to alcohol & controlled substance testing requirements by 49 CFR Part 40?* Yes No Please note that Oddson Underground, Inc, reserves the right to contact previous employers to verify past employment Are you an American Citizen?* Yes No Have you ever been convicted of, of pleaded no contest, to a felony within the last five years?* Yes No Have you ever been in the Armed Forces? Yes No If Yes, Explain Are you currently a member of the Armed Forces? Yes No If Yes, please list your specialty Date Entered Date Format: MM slash DD slash YYYY By Submitting this I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if & after a condition offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/ or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391 .23(d) and (e). I understand that I have the right to: Review information provided by current/ previous employers, Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer, and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. By submitting this I certify that all of the information is true and complete to the best of my knowledge. Consent I agree to the privacy policy.
