Skip to content

225-228-2773
info@rosco-res.com
Office Directions

Facebook-f Linkedin

Home
About Us
Services
Safety
Contact Us

Home
About Us
Services
Safety
Contact Us

Home
About Us
Services
Safety
Contact Us

Home
About Us
Services
Safety
Contact Us

Job Opportunities

CDL Job Application

Step 1 of 8 - Applicant Information

12%

Applicant Information

Name(Required)

First Last

Phone

Email(Required)

Date of Birth

MM slash DD slash YYYY

Social Security #

Date of Application

MM slash DD slash YYYY

Position Applied For

Date Available For Work

MM slash DD slash YYYY

Do you have legal right to work in the United States?(Required)

Yes

No

Previous Three Years Residency

Current Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

# of years at current address

Mailing Address (if different)

Street Address City State / Province / Region ZIP / Postal Code

Previous Address 1

Street Address City State / Province / Region ZIP / Postal Code

Previous Address 2

Street Address City State / Province / Region ZIP / Postal Code

Previous Address 3

Street Address City State / Province / Region ZIP / Postal Code

License Information

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.

Licenses held in the past 3 years

State

License #

Type/Class

Endorsements

Expiration Date

Previously held licenses (if any)

State

License #

Type/Class

Endorsements

Expiration Date

Driving Experience

Driving experience (past 3 years)

Class of Equipment

Type (Van/Tank/Flat/etc.)

Date From

Date To

Approx # Miles (Total)

Accident Record (Past 3 Years)

Check if none

No accidents to report

Accidents

Date

Nature of Accident

Fatalities

Injuries

Chemical Spills (Y/N)

Traffic Convictions & Forfeitures (Past 3 Years)

Other than parking violations.

Check if none

No convictions/forfeitures to report

Convictions/Forfeitures

Date Convicted (MM/YYYY)

Violation

State

Penalty

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

No

If yes, explain

Has any license, permit, or privilege ever been suspended or revoked?

Yes

No

If yes, explain

Employment History (Current / Most Recent Employer)

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment 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.

Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Employer Name

Employer Phone

Employer Address (street, city, state, zip)

Position Held

From (MM/YYYY)

To (MM/YYYY)

Salary

Reason for Leaving

Explain any gaps in employment (month/year & reason)

While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

Yes

No

Was the job designated as a safety-sensitive function in a DOT-regulated mode (49 CFR Part 40 testing)?

Yes

No

Second (Most Recent) Employer

Employer Name

Employer Phone

Employer Address (street, city, state, zip)

Position Held

From (MM/YYYY)

To (MM/YYYY)

Salary

Reason for Leaving

Explain any gaps in employment (month/year & reason)

Subject to FMCSRs while employed here?

Yes

No

Safety-sensitive DOT function subject to alcohol/controlled substances testing (49 CFR Part 40)?

Yes

No

Third (Most Recent) Employer

Employer Name

Employer Phone

Employer Address (street, city, state, zip)

Position Held

From (MM/YYYY)

To (MM/YYYY)

Salary

Reason for Leaving

Explain any gaps in employment (month/year & reason)

Subject to FMCSRs while employed here?

Yes

No

Safety-sensitive DOT function subject to alcohol/controlled substances testing (49 CFR Part 40)?

Yes

No

Education

Education History

School

Name & Location

Course of Study

Years Completed

Graduate (Y/N)

Details

Other Qualifications

Please list any other qualifications that you have and which you believe should be considered.

To be read and signed by applicant

I authorize Rosco Contracting, LLC to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior 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. 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 resend 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.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Applicant Signature(Required)

Date(Required)

MM slash DD slash YYYY

Applicant Name (printed)

Employment Record

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).

IN PROGRESS

Safety Performance History Records Request - Part 1

To be completed by prospective employee

Applicant Name (print)

First Middle Last

Social Security Number

Date of Birth

MM slash DD slash YYYY

Previous Employer (name)

Previous Employer Email

Previous Employer Telephone

Previous Employer Address

Street Address Address Line 2 City State ZIP Code

Applicant Signature(Required)

Signature Date(Required)

MM slash DD slash YYYY

Check to confirm:

I hearby authorize my previous employee to release and forward the information requested by Rosco Resources concerning my Alcohol and Controlled Substances Testing records within the previous 3 years

Safety Performance History Records Request - Part 2

To be completed by previous employer

IN PROGRESS; SEEKING CLARIFICATION FROM ROSCO ON HOW TO HANDLE

Safety Performance History Records Request - Part 3

To be completed by previous employer

IN PROGRESS; SEEKING CLARIFICATION FROM ROSCO ON HOW TO HANDLE

Records Request for Driver/Applicant Safety Performance History

This request is made by the driver/applicant in compliance with the Department of Transportation regulations.

Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business-days deadline will begin when the prospective employer receives the requested safety-performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.

Driver/Applicant Name

Social Security / I.D. #

Driver/Applicant Address

Street Address Address Line 2 City State ZIP Code

Driver/Applicant Telephone #

I am submitting this written request to obtain copies of my Department of Transportation Safety Performance History for the preceding three years. I understand, for records requested from a prospective employer, that I must arrange to pick up or receive the requested records within thirty (30) days of the records being made available or I have waived my request to review the records.

This information should be:

Sent to me at the above address

I will arrange to pick up

Driver/Applicant Signature(Required)

Date

MM slash DD slash YYYY

Annual Review of Driving Record

MOTOR CARRIER INSTRUCTIONS: Review the driver’s motor vehicle record, annual Certification of Violations, and other information described in 49 CFR 391.25 of the Federal Motor Carrier Safety Regulations. Complete the information requested below.

Driver Name

First Middle Last

Social Security Number

Date of Employment

MM slash DD slash YYYY

Home Terminal (City and State)

Drivers License Number

Drivers License State

Drivers License Expiration Date

MM slash DD slash YYYY

Check one to confirm:

I have reviewed the driving record of the above named driver in accordance with 49 CFR 391.25 and find that he/she:

Meets minimum requirements for safe driving

Is disqualified to drive a motor vehicle pursuant to Section 391.15

Actions taken with driver:

Motor Carrier Name

Motor Carrier Address

Street Address Address Line 2 City State ZIP Code

Reviewer Title

Reviewer Signature

Date. of Review

MM slash DD slash YYYY

Authorization to Obtain Motor Vehicle Record

THE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFY AS FOLLOWS:

Certifies that the undersigned is an employee, or has applied to become an employee of the below named employer in a position which involves the operation of a motor vehicle and the undersigned gives his or her consent to the release of their driving record (MVR) for review by: ROSCO CONTRACTING, LLC

That the undersigned authorizes his or her driving record to be periodically obtained and reviewed for the purpose of initial and continued employment.

That all information presented in this form is true and correct. The undersigned makes this certification and affirmation under penalty of perjury and understands that knowingly making a false statement or representation on this form is a criminal violation.

Employee/Potential Employee Name (print as on license)

License Number & State

Date of Birth

MM slash DD slash YYYY

Employee/Potential Employee Signature

Signature Date

MM slash DD slash YYYY

Drug & Alcohol Clearinghouse Consent for Limited Queries

NOTICE TO DRIVER: The Commercial Drlver's License (COL) Drug & Alcohol Clearinghouse Is a federal database containing information about COL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations In 49 CFR Part 382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both at the time of hire and annually. When conducting an annual Inquiry, the motor carrier has the option to request a "limited" report that only indicates whether the Clearinghouse has any information about you; It does not release any violation or testing information. Before a motor carrier may request a limited report, they must have your written authorization, per 38.701(b). This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log In to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain your full Clearinghouse record.

NOTICE TO THE MOTOR CARRIER: This consent for authorizes you to· run a· "limited-query'' to check whether the· Clearinghouse has information about the driver identified below. If it does, then you must obtain a full Clearinghouse record within 24 hours, per 382.701(b). This consent form must be retained until 3 years after the date of the last limited query you perform for this driver, based on the authorization below.

AUTHORIZATION:

I hereby authorize Rosco Contracting to conduct limited annual queries of the FMCSA's Drug & Alcohol Clearinghouse, to determine If a Clearinghouse record exists for me. This consent is valid from the date shown below until my employment with the above-named motor carrier ceases or until I am no longer subject to the drug and alcohol testing rules In 49 CFR Part 382 for the above-named motor carrier.

I understand that if any limited query reveals that the Clearinghouse contains information about me, I must grant electronic consent within 24 hours, via the Clearinghouse website, for the motor carrier to obtain my full Clearinghouse record. Refusal to provide such consent will result in my removal from safety-sensitive duties.

Click to confirm:(Required)

I agree with above statement

Driver's Printed Name

Date

MM slash DD slash YYYY

Signature

Social Security Number

Previous Pre-Employment Alcohol and Drug Test Statement

As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT Agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of return-to-duty process.

Driver's Name (printed)

In accordance with Federal Motor Carrier Regulations Section 40.25(j), the driver must respond to the following questions.

In the past two years, have you tested positive or refused to test on any pre-employment drug or alcohol test (for DOT-covered work) where you did not obtain the job?

Yes

No

If yes, can you provide proof that you’ve successfully completed DOT return-to-duty requirements?

Yes

No

Not Applicable

Click to confirm:(Required)

I certify that the information provided on this document is true and correct.

Driver's Signature

Date

MM slash DD slash YYYY

Witnessed by (name)

First Last

Driver's Signature

Witness Date

MM slash DD slash YYYY

Important Notes

The job application must be completed in full, or it will not be considered.

Save Your Progress

Need to take a break? You can save your progress at the bottom of this page and return to the form at a later date.

Questions?

Get in touch with Rosco Resources.

Explore Our Site

About Us

Services

Access
Sitework
Civil Construction
Disaster Response
Traffic Control

Safety

Careers

Contact Us

Access
Sitework
Civil Construction
Disaster Response
Traffic Control

Questions? Get in Touch!

225-228-2773
info@rosco-res.com
Office Directions

Facebook-f Linkedin

© Rosco Resources 2026. All rights reserved.