• Employment Application

    Employment Application

    PO Box 393, Killdeer, ND 58640

  • Applicant Information

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
    • Applicant Information 
    • Format: (000) 000-0000.
    • Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Position Information 
    • Date Available for Work
       - -
      2 digit month, 2 digit day, 4 digit year
    • Do you have the legal right to work in the United States?*
    • Emergency Contact Information 
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.

  • Residence History

    Please provide a complete 3-year residence history.
    • Current Residence 
    • Current Residence*
    • Have you lived at this address for 3 years or more?*
    • Previous Residences 
    • List Previous Residences (if current residence is less than 3 years old)*
    • From Phone: If You Need More Space Please Clearly Write or Type Out the Information and Take a Photo Here
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  • License Information

    No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years.
    • License Information 

    • Current License Information

    • Current License*

    • From Phone: Use The Buttons Below To Take Pictures Of The Front And Back Of Your Current License

    • Front Of Current License
    • Back Of Current License
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    • Have you had your current license for 3 years or more?*
    • Previous License Information (If Needed) 

    • Previous License Information

    • List Previous Licenses (if current license is less than 3 years old)*
    • Previously Held License
    • Previously Held License
    • From Phone: If You Need More Space Please Clearly Write or Type Out the Information and Take a Photo Here
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    • Med Card Information 

    • Med Card Information

    • Med Card Expiration Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • From Phone: Use The Buttons Below To Take A Picture Of Your DOT Medical Card. Make sure the Med Card is clearly readable.
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  • Driving History

    Please provide a complete driving history, including your driving experience for as many years as are relevant, and accident and traffic violations for the last 3 years.
    • Driving Experience 

    • List the Class and Type of Equipment You Have Experience Using and Approx # of Years for Each, Including Any Endorsements

    • Add another section for each equipment Class and Type you have experience operating.
    • Accident Record For The Past 3 Years 
    • Have you had any accidents in the last 3 years?*
    • List All Accidents You Have Been Involved In Over The Past 3 Years, Most Recent First. (Use the +Add Row button to include additional accidents.) If None Write N/A In One Of The Fields.*
    • Traffic Convictions For The Past 3 Years (Other Than Parking Violations) 
    • Have you had any traffic violations in the last 3 years?*
    • List Most Recent Violations First. (Use the +Add Row button to include additional violations.) If None Write N/A In One Of The Fields.*
    • License Denial, Suspension, or Revocation 
    • 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?*

  • Employment History

    The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backward (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state,zip; and complete all other information.
    • Current Employer 
    • Current/Most Recent Employer*
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?*
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?*
    • Previous Employer(s) 
    • List Previous Employers For a Complete 10 Year History *
    • Have you had any gaps in employment for more than 1 month in the last 10 years?*
    • Gaps In Employment 
    • Second Most Recent Employer
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • Third Most Recent Employer
    • While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
    • Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
    • From Phone: If You Need More Space Please Clearly Write or Type Out the Information and Take a Photo Here
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  • Education and Qualifications

    • Education 

    • High School

    • Graduated
    • Did you attend college?*
    • Did you attend Driving/Trade School?*
    • College 

    • College

    • Graduated*
    • Driving or Trade School 

    • Driving or Trade School

    • Graduated*
    • *
      Rows
    • Other Qualifications 

  • Authorization

  • I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.


    In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of NorthPoint Transport.
    I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:
    • Review information provided by current/previous employers;
    • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and
    • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.


    This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: