Howard Logistics Driver Application For Employment Company*Street Address*City, State & Zip Code*NameFirst*MiddleLast*AddressStreet*City*State & Zip Code*How Long?Date of Birth*Hire Date*Telephone Number*Email address*Previous Three Years ResidencyStreet, City, State & Zip Code# YearsStreet, City, State & Zip Code# YearsStreet, City, State & Zip Code# YearsLicense InformationSection 383.21 FMCSR states " No person who operates a commercial vehicle shall at any time have more than on driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.State*License Number*Type*Expiration Date*Driving ExperienceClass of EquipmentEquipment TypeDatesApprox. # of MilesStraight Truck Tractor & Semi-Trailer Tractor & Two Trailers OtherAccident Record For Pat Three YearsDateNature of Accident Fatalities InjuriesChemicalSpillsYesNoYesNoYesNoTraffic Convictions For Past Three Years Or MoreDate ConvictedViolationState Of ViolationPenaltyForfeited bond, collateral and/or pointsForfeited bond, collateral and/or pointsForfeited bond, collateral and/or pointsA. Have you ever been denied a license, permit or privilege to operate a motor vehicle?YesNoIf yes, explainB. Has any license, permit or privilege ever been suspended or revoked?YesNoIf yes, explainSendThis field should be left blank
