Personal Information

    Are you a U.S. citizen?
    Are you authorized to work in the U.S.?
    Have you ever been convicted of a felony?
    Have you served in the U.S. military?

    Objective

     

    Locations

     
     
    Please submit a photo copy of your driver's license. By completing this application and submitting your driver's license, you are consenting Coastline Transport to run your current Motor Vehicle Report (MVR). An MVR is required to check the validity of your driving record and history and is used to verify your legal right to drive. If you are unable to upload your driver's license, you may text it to 559-834-3074.
    No file attached.
    Enter the first year you received your CDL license.
    Enter your driver's license number and state of issuance here.
    Are you currently employed?
    I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am:
    Select one box below
    Select type of driving you CAN and WILL do.
    What type of equipment have you operated?
    Check all that apply.
    List any other employers over the last three years here. If you need to list more than 2, enter the 3rd employer below.
    List your 3rd former employer here.
    Are you currently, or have been, enrolled in an Substance Abuse Program (SAP)?
    Number of traffic convictions for past 3 years.
    Select the number of traffic convictions you have had in past 3 years.
    Have you been convicted of Driving Under the Influence (DWI, DUI, etc) in the past 3 years?
    Number of accidents (regardless of fault) in the past 3 years.
    I hereby provide consent to Coastline Transport to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I further understand that if I refuse to provide consent for Coastline Transport to conduct a limited query of the Clearinghouse, Coastline Transport must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
    I understand as required by the Federal Motor Carrier Safety Regualations, 49 CFR Part 391.03 and company policy, all prospective drivers must submit to a controlled substances test. I understand, if I test positive for a use of controlled substance(s), I am not medically qualified to operate a commercial motor vehicle in interstate commerce. I also understand I will be given a reasonable opportunity to confer with the company's Medical Review Officer before any positive test result is reported to the company. The results will not be released to any additional parties without my written authorization.

    I hereby agree to submit to a urine drug test.
    Enter today's date, your Social Security Number and your full name.
    Enter your name and driver's license number if you have read and understood the above.

    Coastline Transport - Drug and Alcohol Testing Program vM18

    In accordance with 49 CFR 382.601(a), Coastline Transport is providing a copy of our Drug and Alcohol Testing Program policy. It is your responsibility to read and understand this policy. Your Digital Signature on this application will serve as your receiving and acknowledgement of the policy.

    Authorization

    I hereby certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.

    I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

    I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

    Digital Signature