Elevated Life Business Driver Application Personal Information Full Name (required) Complete Address (required) Phone Number (required) Social Security Number (Required for Drug Test) Date of Birth (required) Email Address (required) Eligibility Questions Are you 18 years of age or older? YesNo Do you have the legal right to live and work in the U.S.? YesNo If hired, can you provide the documentation required by U.S. Law? YesNo Have you ever been convicted of a misdemeanor or felony? YesNo Have you ever been employed with Elevated Life Business? YesNo Address History Current Address (required) Number of Years at Current Address (required) Previous Address (required) Number of Years at Previous Address (required) License Information CDL License Number (required) License Expiration Date (required) Medical Card/DOT Physical Expiration Date (required) Previous Licenses Held Driving History Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo Has any license ever been suspended? YesNo Have you ever been disqualified for violations regarding Safety Regulations? YesNo Employment Status Are you currently employed? (required) YesNo If employed, may we contact your current employer? YesNo If accepted, when would you be available to start? (required) Employment History Most Recent Employer Employer Name (required) Position Held (required) From Date (required) To Date (required) City/State (required) Employer Phone Number (required) Equipment Operated (required) Previous Employer 2 Employer Name (required) Position Held (required) From Date (required) To Date (required) City/State (required) Employer Phone Number (required) Equipment Operated (required) Reason for Leaving (required) Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR's)? YesNo Previous Employer 3 Employer Name (required) Position Held (required) From Date (required) To Date (required) City/State (required) Employer Phone Number (required) Equipment Operated (required) Reason for Leaving (required) Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR's)? YesNo Materials Hauled (required) Reason for Leaving (required) Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR's)? YesNo Previous Employer Employer Name (required) Position Held (required) From Date (required) To Date (required) City/State (required) Employer Phone Number (required) Equipment Operated (required) Reason for Leaving (required) Were you subject to the Federal Motor Carrier Safety Regulations (FMCSR's)? (required) YesNo Additional Information Explain any gaps in employment (include month/year) Please list any qualifications you believe should be considered (Endorsements, etc) List any accidents in the last 3 years (Date, Nature of Accident, Fatalities & Injuries) List any violations in the last 3 years (Date, Type, State & Penalty) Required Documentation Upload Photo of Your CDL (required) Upload Photo of Your Medical Card (required) Terms and Conditions I hereby certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand and agree that a background check and drug test will be required as a condition of employment, and I hereby authorize such investigations. I understand that I will be required to comply with all Federal Motor Carrier Safety Regulations (FMCSR) and company policies if hired. Certification Today's Date (required) Δ
