Commercial Driver’s License (CDL) Form

Driver's License Information
License Number*
Class of License*
Expiration Date*
State*
State
Have you had your driver's license suspended or removed?*
- Yes
- No
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
- Yes
- No

Previous Address (Past Three Years)
Please list your previous three addresses (1 of 3)*
Street Address City State ZIP Code
Do you have another previous address to add?
- Yes, I have another
- No, I don't have any more
Please list your previous three addresses (2 of 3)*
Street Address City State ZIP Code
Do you have another previous address to add?
- Yes, I have another
- No, I don't have any more
Please list your previous three addresses (3 of 3)*
Street Address City State ZIP Code

Types of Vehicles
Have you driven utility vehicle(s)?*
- Yes
- No
Please describe the utility vehicle(s) you have driven
List the approximate dates that you drove that vehicle(s)
Approximate number of miles
Have you driven a semi with a trailer?*
- Yes
- No
List the approximate dates that you drove that vehicle
Approximate number of miles
Have you driven a combination truck >26K GW? and Trailer > 10K GW?*
- Yes
- No
List the approximate dates that you drove that vehicle
Approximate number of miles
Have you driven any other commercial vehicles you would like to add?*
- Yes
- No
Please describe the vehicle
List the approximate dates that you drove that vehicle
Approximate number of miles

Accident Record (Past Three Years)
Have you had any accidents in the past three years? (1)
- Yes, I have
- No, I have not
Type of accident (Head-on, Rear-end etc.)
Date of incident
Type of equipment you were driving
Were there any injuries or deaths? Please describe below:
Were there any chemical spills or environmental damage? Please describe below:
Do you have another accident to add? (2)
- Yes, I have another to add
- No, I have no more to add
Type of accident (Head-on, Rear-end etc.)
Date of incident
Type of equipment you were driving
Were there any injuries or deaths? Please describe below:
Were there any chemical spills or environmental damage? Please describe below:
Do you have another accident to add? (3)
- Yes, I have another to add
- No, I have no more to add
Type of accident (Head-on, Rear-end etc.)
Date of incident
Type of equipment you were driving
Were there any injuries or deaths? Please describe below:
Were there any chemical spills or environmental damage? Please describe below:

Traffic Convictions & Forfeitures (Past Three Years)
Do you have any traffic convictions or forfeitures in the past three years? (1)
- Yes, I do
- No, I do not
Date of incident
Violation
Penalty
Location / State
Do you have another traffic convictions or forfeitures to add? (2)
- Yes, I do
- No, I do not
Date of incident
Violation
Penalty
Location / State
Do you have another traffic convictions or forfeitures to add? (3)
- Yes, I do
- No, I do not
Date of incident
Violation
Penalty
Location / State

General Information