Click for Home Page Pre-Employment and Enrollment Application and
Motor Carrier Certification Questionnaire

Please fill out this form and click the 'Send Form' button at the bottom of the page.
Version 7

Employment Policies


This is an application for enrollment in Dedicated Services' Advantage Driver University. Enrollment in the program is subject to the terms and conditions of the Enrollment Agreement and any tuition assistance program should you qualify.

Dedicated Services is an Equal Employment Opportunity Employer. Qualified applicants are considered for all positions without regard to race, religion, sex, national origin, sexual orientation, age, marital status, public assistance or disability, or any other legally protected status. No question on your application is intended to secure information used for such discrimination. All applicants and employees will be treated in conformity with all existing laws.

Except as provided in the Enrollment Agreement, employees of Dedicated Services are employed at will. This means you have the right to resign from your employment at any time, for any reason. Similarly, Dedicated Services has the right to terminate the employment of our employees with or without cause, and without notice at any time.

During the life of the Enrollment Agreement, your employment with Dedicated Services shall be governed by its terms having a 1 year exclusive services agreement by you. Enrollment in Advantage Driver University is not a guarantee of employment beyond the terms of the Enrollment Agreement.

NOTE: If you are conditionally hired, a copy of this form may be given to a motor carrier (to whom we have contracted the tractor you will be driving) for use in certifying you under its requirements and DOT Regulations. You will not be an employee of that motor carrier. In most cases the carrier will need you to fill out its questionnaire.
 

Dedicated Services Application
Area of Interest:

For a quick response, please complete all areas
How did you find out about us?
If by another driver, please put their
name and/or number here:
How are you completing this application?
If "Other Place", please
enter here:

Attention Recruiter:
First Name: Middle: Last:
 
Address City State Zip How Long? (years)
Present:
 
Previous:
U.S. Citizen: Yes No If No, do you have the legal right to work in the U.S.? Yes No
     
Home Phone:  
Cell Phone:  
Pager:  
Email Address:  
Verify Email:  
Birth Date:  
Social Security Nbr*:  
Federal ID #:  


*DOT requires this information F.M.C.S.R. 391.21(2)

 

How long are you willing to be away from home prior to returning?    Days    Weeks    Months
Yes No Are you at least 21 years old?
Yes No Do you have a Class A CDL?
Yes No Do you have a Haz Mat endorsement?
Yes No Do you have interstate experience driving a tractor/trailer combination?
Yes No Are you willing to drive anywhere in the U.S. and Canada?
Yes No Are you willing to work in a pre-planned dispatch system and comply with Federal Motor Carrier Safety Regulations?
Yes No Are you willing to comply with a reasonable dress code?
Yes No Are you willing to load and unload freight and properly secure it?
Yes No If offered conditional employment, are you willing to complete the certification process of the carrier or carriers to which we lease?
Please explain any "No" answers below:


EducationHigh SchoolTruck Driving SchoolCollege/University/Other
School Name
Level Completed
Diploma/Degree


Personal Reference (Non-family member)
Name Phone Relationship
Name Phone Relationship


By initialing below, I certify that this pre-employment and enrollment application was completed by me, and
the information is true and complete to the best of my knowledge. This
application may be given to the motor carrier for its records as part of the
certification process under D.O.T. regulations. I hereby authorize the
motor carrier to release to Dedicated Services all information that they receive through
the certification process. I also understand that false or misleading information
given in my application may result in non-hiring or discharge.

I also hereby authorize the release of all records and information regarding
job performance from prior employers or parties with whom I have
contracted and any driver training program. I release them from any and all liability regarding information
they furnish Dedicated Services or the motor carrier to whom I will be assigned if
employed as a driver.

I understand that employees of Dedicated Services are employed at will except as provided in any Enrollment Agreement. I
understand that this means I have the right to resign from my employment at any time for any reason except as provided
in any Enrollment Agreement. Similarly, Dedicated Services has the right to terminate the employment of their employees
with or without cause, and without notice, at any time except as provided in any Enrollment Agreement. I understand
that enrollment in Advantage Driver University is not a guarantee of employment beyond the terms of the Enrollment Agreement.

Initials:  

Driving History

Driving Experience
Type Years Experience Miles States Operated In
Semi
Straight truck/Other
Driving School:
Name:
Address:
City: St: Zip:
Date Graduated:
Phone #:

 

Driver's Licenses
List ALL driver's licenses you have held during the past 5 years
State License Number Class Expiration Date Haz Mat Endorsement
Yes No
Yes No
Yes No
List any additional licenses here:

 

Have you ever had a license refused, revoked, or suspended? Yes No
Tested positive for any drug and/or alcohol test? Yes No
Refused to take any drug and/or alcohol test? Yes No
Within the past 10 years have you been convicted* of, or have
pending, any charges for driving under the influence (DUI or DWI)?
Yes No
Within the past 10 years have you been convicted* of, or have
pending, a misdemeanor or felony?
Yes No

If yes to either of the two questions above, please explain (include the charge, state, county and date, and
explain any restrictions the conviction, probation, or pending charge places on you truck operation):

 

*DOT requires this information F.M.C.S.R. 391.21(2)

* Please note convictions are not necessarily a bar to certification as a driver

 

List ALL moving violations and accidents that have occurred in the last 5 years, regardless of vehicle type. Not including parking tickets.

Moving Violations
Date Location (State) Violation (if speeding, show rate of speed) Penalty/
Amount of fine
Accidents
Date Preventable Injuries/deaths Ticketed $ Damage Location (State) Accident Description
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 Yes No Yes No

 

Please answer Yes or No to the following questions. Are you physically able, with or without a reasonable accommodation, to:
Yes No Operate a commercial motor vehicle for long periods of time?
Yes No Repetitively move freight weighing up to 50 pounds (occasionally 100 pounds) up to 53 feet?
Yes No Climb in and out of an over-the-road tractor 8 to 10 times per day?
Yes No Conduct a daily tractor trailer inspection as required by the D.O.T.?
Yes No Reach above shoulder level with both arms to load and unload freight for extended periods of time?
Yes No Accurately comply with hours-of-service regulations?
Yes No Perform inspections required by FMCSA on a tractor and trailer and make minor repairs as needed?
Yes No Are there any special accommodations necessary? If yes, please explain:
Please explain any "No" answers below:



Work History
Please list all driving or non-driving experience in the last 3 years.
According to DOT rules, you must provide up to 10 years of driving history, if you are so experienced.

Have you ever been discharged or suspended from a job?Yes No
If Yes, please explain in appropriate 'Reason for Leaving' space below.
 
OK to contact current employer?Yes No
 
Name of Employer:
City: State: Zip:
Contact Name:
Phone: Number of States Ran:
Position:
Dates: From To
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations?  Yes No
Was the position subject to FMCSR drug and alcohol testing regulations?  Yes No
If a driving position, were you an owner operator or a company driver?  Owner Operator Company Driver
If a driving position, what type of equipment did you operate?

Name of Employer:
City: State: Zip:
Contact Name:
Phone: Number of States Ran:
Position:
Dates: From To
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations?  Yes No
Was the position subject to FMCSR drug and alcohol testing regulations?  Yes No
If a driving position, were you an owner operator or a company driver?  Owner Operator Company Driver
If a driving position, what type of equipment did you operate?

Name of Employer:
City: State: Zip:
Contact Name:
Phone: Number of States Ran:
Position:
Dates: From To
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations?  Yes No
Was the position subject to FMCSR drug and alcohol testing regulations?  Yes No
If a driving position, were you an owner operator or a company driver?  Owner Operator Company Driver
If a driving position, what type of equipment did you operate?

Name of Employer:
City: State: Zip:
Contact Name:
Phone: Number of States Ran:
Position:
Dates: From To
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations?  Yes No
Was the position subject to FMCSR drug and alcohol testing regulations?  Yes No
If a driving position, were you an owner operator or a company driver?  Owner Operator Company Driver
If a driving position, what type of equipment did you operate?

Name of Employer:
City: State: Zip:
Contact Name:
Phone: Number of States Ran:
Position:
Dates: From To
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations?  Yes No
Was the position subject to FMCSR drug and alcohol testing regulations?  Yes No
If a driving position, were you an owner operator or a company driver?  Owner Operator Company Driver
If a driving position, what type of equipment did you operate?

Please send me additional information:Yes No

Enter any additional comments here:


By initialing and clicking below to submit my information, I:
          • I certify that this questionnaire was completed/reviewed by me, and the information is true and complete to the best of my knowledge.
          • I hereby authorize the release of all records regarding the job performance from prior employers or parties with whom I have
            contracted, and I release them from any and all liability regarding information they provide.
          • I authorize Dart Transit Company or Mainstream Transportation, Inc. to investigate my background, credit rating, any possible
            criminal record, and prior work history, and agree that any misrepresentation or omission of facts is a legitimate cause for denial
            of certification or cancellation of certification. This is a questionnaire for certification, not employment.
          • I also authorize the release of information to the Safety Qualification Technician at Dart or Mainstream concerning (i) all positive
            drug test results during the past three (3) years; (ii) all alcohol test results of 0.04 or greater during the past three (3) years; (iii) all
            alcohol test results of 0.02 or greater but less than 0.04 during the past three (3) years; (iv) all instances in which I refused to submit
            to a DOT required drug and/or alcohol test during the past three (3) years; and (v) all other violations of DOT agency drug and
            alcohol testing regulations This is in accordance with Federal Motor Carrier Safety Regulations 49 CFR§§§§40.25, 40.321,
            382.405, and 382.413.
          • Furthermore, I submit that I have been expressly notified of my rights regarding the investigative information provided to Dart or
            Mainstream as outlined in FMCSR §391.23(i), which includes:
            • The right to review information provided by previous employers.
            • The right to have errors in the information corrected by the previous employer and for that employer to re-send that corrected
              information to Dart or Mainstream.
            • The right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot
              agree on the accuracy of the information.
          • I understand that in order to receive such investigative information I must submit a written request per §391.23(i) to Dart or
            Mainstream at any time prior to or within 30 days after being notified of approval or denial of qualification for certification.
          • I authorize Dart Transit Company, Mainstream Transportation, Inc. and any other Dart Network company to contact me regarding driver opportunities within the Dart Network now and/or in the future including via an automated telephone dialing system and/or pre-recorded message at the contact number(s) I provided above. I understand that I may revoke this consent at anytime by contacting a Dart Network recruiter.
 
Initials:  

Thank you for your information. We look forward to speaking with you soon!
Please also print out, sign and fax back the release form (green link below) to expedite your application.
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Click here for the Release Form | PSP Report Disclosure and Authorization Form | Electronic PSP Report Disclosure and Authorization Form
Note: Adobe Acrobat Reader is required.
 
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