Career – Focus1 Logistics

1. Applicant Information

First Name *

Middle Name

Last Name *

Social Security Number *

Phone *

Email

Date of Birth *

Date Available for Work

Position Applying For:

CDL

Non-CDL

Local

Regional

OTR

Do you have legal authorization to work in the U.S.? *

YES

NO

2. Residency - Previous 3 Years (Required under §391.21(b)(8))

Provide all addresses for the past 3 years.

Current Address

Street Address *

City *

State

ZIP

From (Mo/Yr)

To (Mo/Yr)

3. Licensing Information (Required under §391.21(b)(5))

Are you disqualified from operating a CMV per FMCSR 391.15?

Yes

No

FMCSA Requirement Notice: Drivers may not hold more than one valid driver's license at any time (49 CFR 383.21).

License Number *

State *

Class

Expiration Date

4. Driving Experience (Required under §391.21(b)(7))

Straight Truck (years)

Tractor/Semi-Trailer (years)

Tractor/2+ Trailers (years)

Other (years)

5. Accident History - Past 3 Years (Required under §391.21(b)(6))

Check here if NO accidents in the last 3 years

6. Traffic Convictions - Past 3 Years (Required under §391.21(b)(6))

Exclude parking violations.

Check here if NO traffic violations in the last 3 years

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YES

NO

If yes, explain:

Has any license, permit, or privilege ever been suspended or revoked?

YES

NO

If yes, explain:

7. Employment History - Last 10 Years (Required under §391.21(b)(10) & §391.23)

FMCSA requires:

3 years full employment history, PLUS
7 additional years of CMV (commercial motor vehicle) driving history.

List all employment, starting with the most recent.

Explain any gaps in employment exceeding 30 days (required):

8. Education

High School / College Name

Location (City, State)

Years Completed

9. Other Qualifications

List any special training, skills, certifications, or experience related to transportation:

10. Military Service (Optional)

Branch

From

To

Rank at Discharge

Type of Discharge

If not honorable, explain:

11. Drug & Alcohol Testing Consent (Required under §40 & §391.23)

Have you ever tested positive, refused a test, or violated DOT drug/alcohol testing rules?

YES

NO

If YES, you must provide completion documentation for the DOT-required SAP Return-to-Duty Process.

12. Release & Certification (Required by §391.21(b)(12))

Authorization & Release

I authorize FOCUS 1 LLC to investigate my employment history, driving record, criminal background, drug/alcohol testing history, and any other information relevant to my safety performance under FMCSA regulations.

I release all employers, schools, and agencies from liability for releasing such information.

I understand that:

Providing false or misleading information is grounds for termination.
FMCSA requires prior employers to release safety performance history (§391.23).
I have the right to review and dispute any incorrect safety information.

AT-WILL EMPLOYMENT STATEMENT

I understand that employment with Focus One LLC is at-will and may be terminated by either party at any time, with or without cause.

Applicant Certification

I certify that this application is complete and accurate to the best of my knowledge.

Applicant Signature *

Date *

Printed Name *