For a quick response, please complete all areas
*DOT requires this information F.M.C.S.R. 391.21(2)
In case of emergency notify (must be different then your home phone number)
Do not list relatives or former employers
List ALL driver's licenses you have held during the past 5 years
List ALL moving violations and accidents that have occurred in the last 5 years, regardless of vehicle type. Not including parking tickets.
Please list all driving or non-driving experience in the last 3 years.
Please send me additional information:
According to DOT rules, you must provide up to 10 years of driving history, if you are so experienced.
Enter any additional comments here:
By signing and clicking below to submit my information, I:
- I certify that this questionnaire was completed/reviewed by me, and the information is true and complete to the best of my knowledge.
- I hereby authorize the release of all records regarding the job performance from prior employers or parties with whom I have contracted,
and I release them from any and all liability regarding information they provide.
- I authorize Dart Transit Company or Mainstream Transportation, Inc. to investigate my background, any possible
criminal record, and prior work history, and agree that any misrepresentation or omission of facts is a legitimate cause for denial
of certification or cancellation of certification. This is a questionnaire for certification, not employment.
- I also authorize the release of information to the Safety Qualification Technician at Dart or Mainstream concerning (i) all positive
drug test results during the past three (3) years; (ii) all alcohol test results of 0.04 or greater during the past three (3) years; (iii) all
alcohol test results of 0.02 or greater but less than 0.04 during the past three (3) years; (iv) all instances in which I refused to submit
to a DOT required drug and/or alcohol test during the past three (3) years; and (v) all other violations of DOT agency drug and
alcohol testing regulations This is in accordance with Federal Motor Carrier Safety Regulations 49 CFR§§§§40.25, 40.321,
382.405, and 382.413.
- Furthermore, I submit that I have been expressly notified of my rights regarding the investigative information provided to Dart or
Mainstream as outlined in FMCSR §391.23(i), which includes:
- The right to review information provided by previous employers.
- The right to have errors in the information corrected by the previous employer and for that employer to re-send that corrected
information to Dart or Mainstream.
- The right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot
agree on the accuracy of the information.
- I understand that in order to receive such investigative information I must submit a written request per §391.23(i) to Dart or
Mainstream at any time prior to or within 30 days after being notified of approval or denial of qualification for certification.
- I authorize Dart Transit Company, Mainstream Transportation, Inc. and any other Dart Network company to contact me regarding driver
opportunities within the Dart Network now and/or in the future including via an automated telephone dialing system and/or pre-recorded
message at the contact number(s) I provided above. I understand that I may revoke this consent at anytime by contacting a Dart Network recruiter.
Signature Instructions: Click and
drag your mouse by the "X" below to sign your name. Once complete, you may
submit the questionnaire and sign our General Release forms or submit the questionnaire and sign our General
Release and Highway Sales Credit
Click on each form below to view it before submitting your questionnaire and signing the forms:
Release 1 | Release 2 | Release 3 | Release 4 | Highway Sales Credit Release Form
Thank you for your information. We look forward to speaking with you soon!