Header Image Facebook Link

P O Box 727 Evergreen, AL 36401 ● Phone (251)-226-6911 ● Fax (251)-226-0056

You can also complete our "Printable Version" and fax to 251-226-0056

Previous Three Years Residency
Please type N/A into fields not applicable.

Personal Information
Please type N/A into fields not applicable.

Emergency Contact Information

Driving Experience
Please type N/A into fields not applicable.

Starlight Truck

Tractor/Semi Trailer

Tractor/Two Trailer


Accident Record for past 3 years
Please type N/A into fields not applicable.

Traffic Convictions and Forfeitures for the past 3 years (Other than parking)
Please type N/A into fields not applicable.

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during he preceding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial vehicle in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated a commercial motor vehicle.

Applicants should also list any unemployed time between jobs.

If the applicant has been self-employed, he/she will need to be prepared to give references, vendors, customers, etc to help verify this self-employment.

Last Employer

Second Last Employer

Third Last Employer

Fourth Last Employer

Fifth Last Employer

Sixth Last Employer

Seventh Last Employer

Eighth Last Employer

I have applied for employment with Evergreen Transport, LLC.

It is agreed and understood that any misrepresentation of information given shall be considered an act of dishonesty. It is agreed and understood that Evergreen Transport, LLC or their agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

It is also agreed and understood that under the Fair Credit Reporting Act, I have been told that this investigation may include an investigating consumer report, including information regarding my character, general reputation, personal reputation, personal characteristics, and mode of living.

I also agree to undergo urinalysis and/or breath alcohol testing to determine if I have controlled substances or other prohibited substances present in my system. I understand that if I test positive for controlled substances, I will be subject to immediate denial of employment and/or termination of employment.

I understand that the information I provide in accordance with FMSCA part 391 will be used to contact previous employers, for the purpose of investigating my safety performance and drug and alcohol history information as required by paragraphs (d) and (3) of 391.23(i) regarding information received as a result of these investigations are as follows:

  • 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 previous employer to re-send the corrected information to the prospective employer;
  • 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.

Should I have previous Department of Transportation regulated employment history in the preceding three years and wish to review previous employer-provided investigative information, I understand I must submit a written request to Evergreen Transport, LLC, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. Evergreen Transport, LLC will provide this information within five (5) business days of receiving the written request. If Evergreen Transport, LLC has not yet received the requested information from the previous employer(s), then the five (5) business days deadline will begin when Evergreen Transport, LLC receives the requested safety performance history information. I understand if I don't pick up or receive the requested records within thirty (30) days of Evergreen Transport, LLC making them available, Evergreen Transport, LLC may consider that I am waiving my request to review the records.

By signing below, I hereby voluntarily consent and do hereby authorize Evergreen Transport, LLC to obtain information about me and to consider this information when making decisions regarding my employment at this organization. I understand that I have rights under the FMSCA, including the rights discussed above.

[ Different Image ]