1375 Remington Road, Suite O
Schaumburg, IL 60173
(630) 444-3456

Application for Employment

Driver Authorization Forms

Fill in the form and sign — the completed Application for Employment is generated as a PDF. Your data stays on this device; nothing is uploaded.

Fill in the form and sign — all driver authorization and consent forms are generated as one PDF. Your data stays on this device; nothing is uploaded.

Applicant information

Fields marked * are required.

Is your mailing address the same as your current address?
Are you at least twenty-one (21) years of age?
Do you have the legal right to work in the United States?
Are you currently employed?
Have you ever worked for Matrix Logistics Inc?

Emergency contact

Address history (past 3 years)

All previous addresses of residency for the past 3 years, most recent first.

Driver license

Current license. Per 49 CFR 383.21 you may hold only one driver's license.

Previously held licenses (last 3 years)

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

Education & military

Graduated?
Have you ever served in the military?

Driving experience & qualifications

Accident record (past 3 years)

Have you ever been in a commercial motor vehicle accident?

Traffic convictions & forfeitures (past 3 years)

Other than parking violations.

Have you ever had a traffic violation?
Have you ever been convicted of reckless driving, unsafe driving, or DUI?
Have you ever been convicted of a felony?
Have you ever been convicted of any drug related offenses?

Employment history

List all employment for the last 3 years, plus 7 more years if you drove a commercial vehicle (10 years total). Most recent first.

Your employers for the past 3 years, most recent first. A Safety Performance History records request is generated for each employer you mark. Employers where you were subject to DOT drug & alcohol testing are listed on the past test results authorization.

Employment gaps

Explain any gap in employment longer than 1 month.

References

Three professional references (not relatives or former employers). If you don't have three, list personal, unrelated references.

Additional considerations

Do you have an artificial and/or prosthetic limb?
Do you have vision impairment?
Do you have hearing impairment?
Do you have diabetes?
Do you have a seizure disorder?

Pre-employment drug & alcohol questions

Have you tested positive, or refused to test, on any DOT pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, a safety-sensitive position in the past two years?
Have you ever been convicted of any drug related offenses?
If yes — can you provide documentation that you successfully completed the DOT return-to-duty requirements (49 CFR Part 40, Subpart O)?

Hours of service — last 7 days

Total time on duty (driving and on duty) for each of the 7 days immediately preceding the application. Include any compensated work, even for non-motor-carrier employers.

Were you required to use a record of duty status (driver's log) for 8 or more days within the past 30 consecutive days?
Are you currently working for another employer?
Do you intend to work for another employer while employed by this company?

Certification & signature

By signing, I certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I have read and agree to the Disclaimer and Certification on page 8 of the application, including the authorization to investigate my employment, driving and drug & alcohol testing history.

By signing, I certify that the information I provided is true and correct.

My signature will be placed on each of the following documents, which I have read and agree to: Driver's Rights Information acknowledgement; Fair Credit Reporting Act Disclosure; Motor Vehicle Record Disclosure, Release & Consent; Pre-Employment Screening Program (PSP) Disclosure & Authorization; Background Check Disclosure & Release Authorization; Pre-Employment Drug & Alcohol Notification & Acknowledgement; Authorization to Obtain Past Drug & Alcohol Test Results; General Consent for Limited Queries of the FMCSA Drug & Alcohol Clearinghouse; Safety Performance History Records Request(s); Certification of Compliance with Drivers License Requirements; Hours of Service Record.

The full text of each document is included in the generated PDF. Please review the PDF before submitting it.

The PDF contains the full 8-page Application for Employment, filled in and signed. The PDF contains all authorization forms, filled in and signed. Sections of the Safety Performance History request that are completed by previous employers, and the Drug & Alcohol Test Notification details, are left blank for the company.