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Application for Drivers
Application for Drivers
Apply so we can start doing business today!
General Information
By submitting this information, you are authorizing Intermodal Cargo Services, Co., LLC to review your MVR and Employment History.
List Previous Address If Less Than 3 Years:
Emergency Contact
Driver License
Employment or Lease History
***10 years required. Note: D.O.T. requires that employment for at least three (3) years be shown, and names and addresses of all employers (including non-driving jobs) during the seven (7) years preceding the three (3) years for which the applicant was an operator of a commercial motor vehicle, together with the dates of employment and reason for leaving such employment.***
You Book It... We Move It!!!
Accident Information
***LIST ALL TRAFFIC ACCIDENTS FOR THE LAST THREE (3) YEARS***
No Accidents?
Traffic Convictions
***LIST ALL TRAFFIC TRAFFIC CONVICTIONS FOR THE LAST THREE (3) YEARS***
No Traffic Convictions?
FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT
***DRIVER MUST READ AND AGREE TO THE FOLLOWING*** In accordance with the provisions of Section 604(b) (2) (a) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1966 (Title II, Subtitle D, chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, your previous drug and alcohol test results, and your driving record (MVR) may be obtained on you for driver qualification purposes. These reports are required by Sections 382.413, 391.23 and 391.25 of Federal Motor Carrier Safety Regulations. It is agreed and understood that Intermodal Cargo Services, Co., LLC (the COMPANY) or it's agents may investigate your (the DRIVER) background to ascertain any and all information of concern to your DRIVING record, your CRIMINAL record and your CIVIL record, whether same is of record or not, and the DRIVER releases the COMPANY, it's agents and persons named herein from all liability for any damages emanating from the DRIVER furnishing and the COMPANY investigating such information. I understand that the information provided on this application concerning previous employers may be used, and the Previous employers will be contacted, for the purpose of investigating the applicant's safety performance history. I understand I have the right to: 1.Review Information provided by previous employers; 2.The right to have errors in the information corrected by the previous employer, and for the previous employer to re- send the corrected information to the COMPANY; 3.The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. The DRIVER agrees to furnish such additional information and complete such examinations as may be required to complete the qualification process. It is agreed and understood that this IN NO WAY OBLIGATES THE COMPANY TO qualify the DRIVER. In the event of qualification, Intermodal Cargo Services, Co., LLC reserves the right to obtain periodic driver motor vehicle reports on the DRIVER. NOTICE TO DRIVER'S PREVIOUS EMPLOYERS: The person whose signature and social security number appears below, has applied with Intermodal Cargo Services, Co., LLC, listing you as a past employer/contractor. Under 49 CFR we are required to request the following information from you and in turn, you are required to provide us with this information. By signing below, he/she has authorized your organization to release his/her Drug and Alcohol Testing History, Work History, Accident Involvement, and Equipment Operated information as requested on the accompanying form, to Intermodal Cargo Services, Co., LLC:
Acknowledgement
CHECKING THIS BOX CERTIFIES THAT I HAVE READ AND AGREE TO THE ABOVE AND THAT THIS APPLICATION WAS COMPLETED BY ME AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
Full Name:
Email Address:
Phone Number:
Address:
City:
State:
Zip Code:
How Many Years
At this residence:
Address:
City:
Zip Code:
State:
Name:
Phone Number:
License State:
License Number:
License Type:
Expiration Date:
Date of Birth:
Most Recent Employer:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 1:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 2:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:

Prior Employer 3:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 4:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 5:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 6:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Prior Employer 7:

Address:
City:
State:
Zip Code:
Employer Phone:
End Date:
Start Date:
Position Held:
Reason For 
Leaving:
Accident Date:
Vehicle driven:

Injuries/Fatalities:
Thorough Description of the Event:
Accident Date:
Vehicle driven:

Injuries/Fatalities:
Thorough Description of the Event:
Accident Date:
Vehicle driven:

Injuries/Fatalities:
Thorough Description of the Event:
Location:
Charge:
Penalty:
Date of Incident:
Location:
Charge:
Penalty:
Date of Incident:
Location:
Charge:
Penalty:
Date of Incident:
Location:
Charge:
Penalty:
Date of Incident:
Full Name:
Social Security Number:
Today's Date:
Referred By (or type N/A): 
Check if no accidents in the past 3 years.
Only Check if You Have Had No Traffic Convictions in the Past 3 Years.
Check If Agreed