Drive for Southern Haulers

Driver Application

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How would you like to complete this?

Both paths satisfy FMCSA §391.21. Choose whichever fits your situation.

Complete online

Recommended · ~12 min

Autosaves every field as you type
Type or draw your signature
Submit instantly — reference number on screen
Resume any time from your phone or laptop

Download PDFs to complete in person

Print · sign · bring or mail

Three official Southern Haulers forms
Print, complete by hand, and sign with a pen
Bring to our Vidalia GA office during business hours
Or mail / fax — addresses on each form

Federal-DOT compliant application + PSP authorization + previous-employer release. Every field autosaves as you type — close this tab and resume any time. Date of birth is tokenized on receipt; plaintext is never stored. Your Social Security Number is not collected at this stage — if you receive a conditional offer of employment, we will request it under 49 CFR §391.21 before your first dispatch.

Source Documents

3 forms · 7 pages

You may submit the application online via the digital sections below — every field autosaves as you type. Or download these official Southern Haulers forms, complete by hand, and return in person at our Vidalia, GA office or by fax / email.

Driver's Application for Employment

Identity · 3-year residency · 10-year employment history · Clearinghouse consent

49 CFR 391.21 · JJ Keller form #691 Rev. 1/18

Download PDF

PSP Disclosure & Authorization

FMCSA Pre-Employment Screening Program — standalone document

FMCSA NIC verbatim · stand-alone document

Download PDF

Previous-Employer Safety-Performance Release

Authorizes Southern Haulers to inquire of any/all previous employer(s)

49 CFR 391.23 — investigation and inquiries

Download PDF

§1.A — Acknowledgment of Rights

49 CFR 391.23(d) and (e)

Read the statement below and sign before completing the application.

Position(s) Applied For*

Date of Application*

To be read and signed by applicant

I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to:

Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send 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.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group status.

I have read and acknowledge the 49 CFR 391.23(d)(e) statement above.

Signature — Type your full legal name or draw*

§1.B — Applicant Identity + 3-Year Residency

49 CFR 391.21(b)(2), (b)(3)

Date of birth tokenizes on receipt — plaintext never stored. Social Security Number is NOT collected at this stage; if you receive a conditional offer of employment, you will be asked to provide it under 49 CFR §391.21 prior to your first dispatch.

Full Name*

Date of Birth — required for Commercial Drivers*

Phone*

Current Address (Street · City · State · ZIP)*

Time at Current Address (e.g. 2y 4m)*

Prior Addresses — all in past 3 years*

One per line. Format: street · city · state · zip · dates (mm/yyyy – mm/yyyy)

Do you have the legal right to work in the United States?*

Can you provide proof of age?*

Required for commercial drivers.

Have you worked for this company before?*

Have you ever been bonded?*

Answer only if a job requirement.

Can you perform — with or without reasonable accommodation — the essential functions of the job?*

§1.C — CDL License & Experience

49 CFR 391.21(b)(7), (b)(8) · 383.93

CDL class, experience, route preference, and license photos. Photo uploads run through client-side OCR (Tesseract.js) before tokenization; raw images are deleted from memory once the structured fields are extracted.

CDL Class*

Years of CDL Experience*

Half-year increments accepted (e.g. 3.5 for three and a half years).

Preferred Route Type*

License Photos — Front + Back*

JPEG or PNG · max 8 MB each · OCR extracts CDL #, state, class, expiration. Raw images are not stored after extraction.

Front of LicenseTap to upload photoBack of LicenseTap to upload photo

§1.C — Employment History (10-year for CDL applicants)

49 CFR 391.21(b)(10), (b)(11)

Past 3 years of all employers + past 10 years of any commercial-motor-vehicle employment. Most-recent first.

1 employer listed

Employer 1Employer Name*

From (mm/yyyy)*To (mm/yyyy or 'Present')*

Address — Street · City · State · ZIP*Position Held*Reason for Leaving*

Contact Person*Contact Phone*

Subject to FMCSRs while employed?

Job designated as DOT safety-sensitive (49 CFR Part 40)?

FMCSRs apply to vehicles with GVWR ≥ 26,001 lbs, vehicles for 16+ passengers, or hazardous-materials placard loads.

§1.D — Clearinghouse Limited-Query Consent (Duration of Employment)

49 CFR 382.703 — duration-of-employment consent

Driver authorizes UNLIMITED limited queries of the FMCSA Drug & Alcohol Clearinghouse while employed.

General Consent for Limited Queries of the FMCSA Drug and Alcohol Clearinghouse for the Duration of Employment

I, the "Driver" whose name appears below, hereby provide consent to Southern Haulers LLCto conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. Driver consents to unlimited multiple limited queries, for the duration of employment.

I understand that if the limited query conducted by Southern Haulers LLC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Southern Haulers LLC without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for Southern Haulers LLC to conduct a limited query of the Clearinghouse, Southern Haulers LLCmust prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.

Last Name*

First Name*

Date of Birth (MM/DD/YYYY)*

CDL Number*

State of Issue*

Country of Issue*

Personal Email*

Mobile Phone*

By checking this box I intend this to be my legally binding electronic signature consenting to unlimited limited queries of the Clearinghouse for the duration of my employment with Southern Haulers LLC.

Signature — Type or draw*

Date Signed*

Equivalent source document

PSP Disclosure & Authorization

FMCSA Pre-Employment Screening Program — standalone document

FMCSA NIC verbatim · stand-alone document

Download PDF

§2 — PSP Disclosure & Authorization

FMCSA NIC verbatim · stand-alone document

This Disclosure and Authorization is a FMCSA-mandated stand-alone document. The text below must be read and signed exactly as worded; it cannot be modified.

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Southern Haulers LLC ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize Southern Haulers LLC("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

I have read the PSP disclosure above.By checking this box I intend this to be my legally binding electronic signature authorizing Southern Haulers LLC to obtain my PSP report.

Signature — Type or draw (PSP authorization)*

Name (Please Print)*

Date Signed*

This Disclosure and Authorization form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). The language must be used in whole, exactly as provided.

Equivalent source document

Previous-Employer Safety-Performance Release

Authorizes Southern Haulers to inquire of any/all previous employer(s)

49 CFR 391.23 — investigation and inquiries

Download PDF

§3 — Previous-Employer Safety-Performance-History Release

49 CFR 391.23 — investigation and inquiries

One signed release authorizes Southern Haulers LLC to contact any and all previous employer(s).

I authorize Southern Haulers LLC to obtain information pertaining to my employment from any and all previous employer(s). Information requested could include questions relating to whether my employment included safety-sensitive functions as described in FMCSA regulations, dates of employment, scope of employment, safety information including accident and driving record information, and drug/alcohol testing information for the previous three (3) years. I also authorize release of other reports pertaining to my employment with my previous employers. I will hold all providers of such information harmless and non-liable as verified by my signature below.

I have read the previous-employer release authorization.By checking this box I intend this to be my legally binding electronic signature authorizing Southern Haulers LLC to inquire of my previous employers.

Signature — Type or draw*

Date Signed*

What we collect, why, and how we protect it

What: name, date of birth, contact, CDL details, residency, employment history (10-year for CDL applicants), Clearinghouse query consent, PSP authorization, signature.
Why: required by 49 CFR §391.21 (driver qualification), §382.701 (Clearinghouse query), and §391.23 (background investigation). Not used for marketing.
Privacy posture: we do NOT collect SSN or other sensitive PII on this public form. SSN is requested only after a conditional offer of employment, under the same §391.21 authority, before first dispatch.
Retention: DQF kept for 3 years post-separation (§391.51). Non-hire applications retained for 1 year (FCRA minimum) then destroyed.

Full details: Privacy Policy · Terms of Service. By submitting, you acknowledge you've read both.

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