RDS Driver Application

Driver Information
Full Name: 
Address: 
City: 
State:  Zip: 
E-Mail: 
Phone (w/area code): 
Miscellaneous Information
Years of Experience: 
Hazardous Material Endorsement? Yes  No  (one req'd)
Drivers License#: 
Exp::  State: 
License ever been suspended or revoked? Yes  No  (one req'd)
Where: 
If Yes,explain
Moving violations (last 3 years):: 
If any,explain
Accidents (last 3 years):: 
If Yes, when:: 
Who was at fault:: 
Damage amount:: 
Equipment experience and Number of Years operating
Van:  Tanker: 
Flatbed:  Intermodal: 
Other equipment experience: 
References
Reference Name: 
Phone (w/area code): 
Current Employment Information
Current Employer: 
City: 
State:  Zip: 
Phone (w/area code): 
Contact: 
Position: 
From Year:  to:  Pay Rate: 
Past Employment Information (#1)
Employer: 
City: 
State:  Zip: 
Phone (w/area code): 
Contact: 
Position: 
From Year:  to:  Pay Rate: 
Why did you leave?: 
Past Employment Information (#2)
Employer: 
City: 
State:  Zip: 
Phone (w/area code): 
Contact: 
Position: 
From Year:  to:  Pay Rate: 
Why did you leave?: 
Certification Terms Statement:
I certify that I personally completed this application and that all information is true and correct. I authorize Rail Delivery to conduct a thorough background investigation in accordance with state and federal law and authorize my previous EMs to release any information requested by Rail Delivery and hold them harmless of all liability from the release of said information. Also,in accordance with the provisions of 49 CFR Part 382.405 and 382.413,I hereby authorize and require my previous and/or current EMs specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provision of 49 CFR while in their employment,to Rail Delivery by whatever means is most expedient.
I Accept Certification Terms

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