Employment Verification

Collect DOT Safety Performance History From Past Employers

Obtain driver-authorized employment, accident, and DOT drug and alcohol testing history from a CDL applicant's previous employers in one structured form.

Volt theme
formbuilder.ai/f/commercial-truck-driver-previous-employer-dot-safety-performance-history-verification-form
Commercial Truck Driver Previous Employer & DOT Safety Performance History Verification Form
Driver's Full Legal Name
· · ·
CDL Number & Issuing State
· · ·
Prospective Employer (Requesting
· · ·
Submit

This free Commercial Truck Driver Previous Employer and DOT Safety Performance History Verification Form template gives motor carriers a simple way to request the background information needed when hiring a CDL driver. In the first section, the driver enters their full legal name, CDL number and issuing state, the prospective employer's name and USDOT number, and the previous employer's name. The driver then signs a release authorizing that company to share employment verification, accident history under 49 CFR 390.15(b), and DOT drug and alcohol testing records under 49 CFR 40.25 and 391.23 for the past three years.

The previous employer then confirms whether the driver worked for them and provides dates of employment, the types of commercial motor vehicles operated, and the reason for leaving. They also report any DOT-recordable accidents with details for each one and indicate whether the driver was subject to DOT testing. They disclose any testing violations from the past three years and attach return-to-duty documentation or supporting records when applicable. The form closes with the name and job title of the person completing it. It is built for trucking companies, small fleet owners, safety and compliance managers, driver recruiters, and HR teams that hire CDL drivers.

Moving this process online replaces faxed paperwork and repeated follow-up calls with a single shareable form. Previous employers can respond from any device, and you receive complete, legible answers in one place. The built-in authorization language clearly states the driver's right to review the information, request corrections, and submit a rebuttal statement. This helps you document a consistent, transparent investigation for your driver qualification files. Customize the fields, add your logo, and start verifying driver history today.

3 Pages
19 Questions
~6min To complete
Free Included on every plan
Field types Short Text ×4 Yes / No ×3 Full Name ×2 Signature ×2 termsandconditions daterange Multiple Choice Dropdown Table / Grid choicematrix File Upload Email

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Driver Information & Release Authorization 6 questions
Section 1: Driver Information & Release Authorization (Completed by Driver)
1 Driver's Full Legal Name * Full Name
2 CDL Number & Issuing State * Short Text
3 Prospective Employer (Requesting Motor Carrier) Name & USDOT Number * Short Text
4 Previous Employer Company Name * Short Text
5 I authorize the previous employer named above to release my employment verification, accident history (49 CFR 390.15(b)), and DOT drug and alcohol testing records (49 CFR 40.25 and 391.23) for the past 3 years to the prospective employer named above. I understand I have the right to review this information, request corrections, and attach a rebuttal statement. * termsandconditions
6 Driver's Signature * Signature
Page 2 Employment Verification & Accident History 6 questions
Section 2: Employment Verification & Accident History (Completed by Previous Employer)
1 Was the driver named in Section 1 employed by your company? * Yes / No
2 Dates of Employment (Start – End) * daterange
3 Type(s) of Commercial Motor Vehicle Operated for Your Company * Multiple Choice
4 Reason for Leaving * Dropdown
5 Was the driver involved in any DOT-recordable accidents (49 CFR 390.5) while employed by your company during the past 3 years? * Yes / No
6 Accident Details (complete if Yes; one row per accident) Table / Grid
Page 3 Drug & Alcohol Testing History & Certification 7 questions
Section 3: DOT Drug & Alcohol Testing History & Certification (Completed by Previous Employer)
1 Was the driver subject to DOT drug and alcohol testing (FMCSA or another DOT agency) while employed by your company? * Yes / No
2 During the past 3 years, did this driver have any of the following? (Select N/A if not subject to DOT testing) * choicematrix
3 Return-to-Duty Documentation or Supporting Records (if applicable) File Upload
4 Name of Person Completing This Form * Full Name
5 Job Title * Short Text
6 Contact Email Address * Email
7 Authorized Representative Signature (certifying the information provided is accurate per company records) * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Volt" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Included on every plan — try it free for 7 days

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Category Verification & Approval
Subcategory Employment Verification
Theme Volt
Price Free
Coding required None

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