Request for Reference

As part of the DOT-required background check, we need to confirm details from the past three years of applicant drivers’ employment with DOT-regulated motor carriers. We greatly appreciate your time with this as it ensures we hire safe, qualified drivers.

About You

Your Name(Required)

First Last

Company Name(Required)

Company Address

Street Address Address Line 2 City ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Contact Phone Number (if necessary)

About Former Employee

Name(Required)

First Last

Starting Date(Required)

The date this employee began employment with your company.

Ending Date(Required)

The date this employee ended employment with your company.

Job Title(Required)

Reason for Leaving(Required)

If available

Accident History

Please share any DOT-recordable crashes while employed with your company

Did this person ever fail or refuse a drug test?(Required)

Did they complete return-to-duty process, if applicable

Yes, they did complete return-to-duty process

No, they did not complete return-to-duty process

Would you rehire this person?(Required)

Yes

Why or Why Not?

Additional comments

Is there anything else you would like to share about this employee?

Your Comments/Questions

About You

About Former Employee

Additional comments

Let's make this quick and easy!