Driver Application | Nightfall Express LLC

Electronic Records & Signature Consent (ESIGN Act)

This application is completed and submitted electronically in accordance with the Electronic Signatures in Global and National Commerce Act (ESIGN Act, 15 U.S.C. §7001) and the Government Paperwork Elimination Act (GPEA). By proceeding, you consent to conduct this transaction electronically. Your typed name combined with your chosen PIN constitutes your legally binding electronic signature. For identity verification and tamper-evidence purposes, your IP address, browser information, and the date and time of submission are recorded server-side and stored with your application. You may request a copy of your submitted application at any time by contacting Nightfall Express LLC.

Federal Notice: This application is subject to 49 CFR Part 391. All information provided is subject to verification including motor vehicle record, prior employment, and safety performance history checks as required by the FMCSA.

Personal Information

First Name *

Middle Name

Last Name *

Phone *

Date of Birth *

Street Address *

City *

State *

ZIP Code *

Position Applied For *

Available Start Date

Pay Expectation

CDL License Information

Issuing State *

License Number *

Class *

Expiration Date *

Endorsements

Hazmat (H) Tanker (N) Combination (T) Doubles/Triples (T) Passenger (P) School Bus (S)

Have you ever had your license revoked, suspended, or denied?

YES NO

If yes, explain

Driving Experience

Equipment Class	Type of Equipment	Approx. Miles	Years Experience
Tractor-Trailer
Straight Truck
Other

Accident Record (Last 3 Years)

Date	Nature of Accident	Fatalities	Injuries	Preventable?

Traffic Violations (Last 3 Years)

Date	Violation	State	Penalty

Employment History — Most Recent

Employer Name

Phone

Address

Position Held

From

Salary

Reason for Leaving

Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 testing?

YES NO

Employment History — Second Most Recent

Employer Name

Phone

Address

Position Held

From

Salary

Reason for Leaving

Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 testing?

YES NO

Employment History — Third Most Recent

Employer Name

Phone

Address

Position Held

From

Salary

Reason for Leaving

Gaps in Employment

Subject to Federal Motor Carrier Safety Regulations?

YES NO

Safety-sensitive DOT function subject to 49 CFR Part 40 testing?

YES NO

Education

Level	School Name & Location	Course of Study	Years Completed	Graduate?
High School
College
Other / CDL School

Other Qualifications

List any other qualifications, certifications, or special skills

Authorization & Electronic Signature

I authorize Nightfall Express LLC to make investigations (including contacting current and prior employers) into my personal, employment, financial, and medical history as may be necessary in arriving at an employment decision. I release all persons from liability in responding to inquiries in connection with my application.

I understand that false or misleading information given in my application may result in discharge. I understand my information may be used to investigate my safety performance history as required by 49 CFR 391.23, and that I have the right to review, correct, or rebut any information provided by prior employers.

By submitting this application, I certify that all entries are true and complete to the best of my knowledge. I consent to the use of electronic records and signatures as described in the ESIGN notice above.

I have read and agree to the above authorization and the ESIGN consent notice. I certify that all information provided is accurate and complete. *

Electronic Signature

Full Legal Name *

Date *

Create a 4-Digit PIN * — used to verify your identity

Confirm PIN *

Your PIN uniquely identifies this submission. Your IP address, browser, and timestamp are recorded server-side at the time of submission for tamper-evidence purposes in compliance with 49 CFR 391.23 and the ESIGN Act.

Your information is kept confidential and used only for hiring purposes.