Incident
Wasthevehicle towed
away?
City
State/Province
Were you inacommercial
vehicle?
yes, wasthisa
Department of
Transportation recordable
accident?
Wereyou atfauit?
Wereyou ticketed?
Description
No
NewOrleans
LA
Yes
No
No
Yes
Wasturning left from an
outside double turn lane
onto a 6 lane divided
highway when i was struck
inthepassenger side by a
truck pick up hauling a
Trailer on my step on the
truck they said t had
moved into theirlane I did
not
Tratfic Comvictions \ Violations
Have you had any moving violations or tvafic
convictions inthe past 3years?
Violation Date 082022
Charge/Desoription LaneViolation
Violation State/Province LA
InCommercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Conmunity
Service?
Other Penalty?
Fine Amount (fany) $0-$99
Comments: Fought ticketandwon
Incident
Wasthevehicle towed
away?
City
State/Province
Were you inacommercial
vehicle?
yes, wasthisa
Department of
Transportation recordable
accident?
Wereyou atfauit?
Wereyou ticketed?
Description
No
NewOrleans
LA
Yes
No
No
Yes
Wasturning left from an
outside double turn lane
onto a 6 lane divided
highway when i was struck
inthepassenger side by a
truck pick up hauling a
Trailer on my step on the
truck they said t had
moved into theirlane I did
not
Tratfic Comvictions \ Violations
Have you had any moving violations or tvafic
convictions inthe past 3years?
Violation Date 082022
Charge/Desoription LaneViolation
Violation State/Province LA
InCommercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Conmunity
Service?
Other Penalty?
Fine Amount (fany) $0-$99
Comments: Fought ticketandwon
Incident
Wasthevehicle towed
away?
City
State/Province
Were you inacommercial
vehicle?
yes, wasthisa
Department of
Transportation recordable
accident?
Wereyou atfauit?
Wereyou ticketed?
Description
No
NewOrleans
LA
Yes
No
No
Yes
Wasturning left from an
outside double turn lane
onto a 6 lane divided
highway when i was struck
inthepassenger side by a
truck pick up hauling a
Trailer on my step on the
truck they said t had
moved into theirlane I did
not
Tratfic Comvictions \ Violations
Have you had any moving violations or tvafic
convictions inthe past 3years?
Violation Date 082022
Charge/Desoription LaneViolation
Violation State/Province LA
InCommercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Conmunity
Service?
Other Penalty?
Fine Amount (fany) $0-$99
Comments: Fought ticketandwon
Was thevehicletowed
away?
City
State/Province
Were you in a commercial
vehicle?
If yes, was this a
Department of
Transportation recordable
accident?
Wereyou at fault?
Were you ticketed?
* * * * * e * * * *
Description
No
New Orleans
* * * * * e s s s s * * s s s * * * * e . e * *
LA
Yes
No
No
Yes
Was turning left from an
outside double turn lane
onto a 6 lane divided
highway when I was struck
in the passenger side by a
truck pick up hauling a.
Trailer on my step on the
truck theysaid had
moved into their lane I did
not
Traffic Convictions \Violations
Have you had any moving violations ortraffic
convictions in thepast 3years?
Violation Date 08-2022
Charge / Description Lane Violation
Violation State/Province LA
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community
Service?
Other Penalty?
Fine Amount(if any): $0-$99
Comments: Fought ticket and won
Were you involved in any accidents/incidents with any vehicle in the last 5years (even if not at fault)? Type of Accident / Non-injury
Incident
Date of Accident / Incident 08-2022
Hazmat Accident /
Incident
Wasthevehicle towed
away?
City
State/Province
Were you in a commercial
vehicle?
If yes, was this a
Department of
Transportationrecordable
accident?
Were you at fault?
Were youticketed?
Description
No
No
New Orleans
LA
Yes
No
No
Yes
Was turning left from an
outside doubleturn lane
onto a 6 lane divided
highway when I was struck
in thepassengerside by a
truck pick up hauling a.
Trailer on my step on the
truck they said had
moved into their lane I did
not
Traffic Convictions\Violations
Have youhad any moving violations or traffic
convictions in the past 3years?
Violation Date 08-2022
Charge/ Description Lane Violation
. . * * * * * .
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Violation State/Province LA
In Commercial Vehicle Yes
Fined? Yes
6.Have youever tested
positive, or refused to test
on a pre-employment drug
oralcohol test by an
employer to whom you
applied, but did not obtain
safety-sensitive
transportation work
covered by DOT agency
drug and alcoholtesting
rules in past three years,
or have you ever tested
positive or refused to test
on any DOT-mandated
drug or alcohol test?
No
VehicleAccident Record
Were you involved in any accidents/incidents with any vehicle in the last 5years (even if not at fault)? Type of Accident / Non-injury
Incident
Date of Accident / Incident 04-2022
Hazmat Accident/
Incident
Was thevehicle towed
away?
City
State/Province
Were you in a commercial
vehicle?
If yes, Wasthis a
Department of
Transportation recordable
accident?
Were you at fault?
Were you ticketed?
Description
No
Yes
Louisville
KY
Yes
No
No
No
None
GPA
Hours of Instruction
Border Crossing
Log Books
Federal Motor Carrier
Regulations
Hazardous Materials
No
Yes
Yes
No
Motor Vehicle Record
1. Has any license,permit
or privilegeeverbeen
denied, suspended or
revoked for any reason?
Date
Comment
* * * * * * * * e s t e s e e s s e t s
2. Have you ever been
convicted of driving during
license suspension or
revocation, or driving
without a valid license or
an expired license,or are
any charges pending?
3. Have you ever been
convicted for any alcohol
or controlled substance
related offense while
operating a motor vehicle,
or are any charges
pending?
Date
Comment
* * * * * * * * * * * * * * * .
4. Have you ever been
convicted for possession,
sale or transfer of an
illegal substance
(including but not limited
to,marijuana,
amphetamines, or
derivatives thereof) while
on duty, or are any charges
pending?
Yes
10-2006
Reckless driving
No
Yes
10-2006
Reckless driving
No
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Mostcommontruck
driven
Mostcommontrailer
Trailer length
Military
Country
Branch of Service
Start Date
End Date
Can you obtain your
DD214?
Rank at discharge
United States
Army
10-1994
10-1996
No
E3
Trucking School
Start Date
End Date
School
Address
Address 2
City, State/Province
Country
Phone
Did you graduate?
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
attending thistruck
school?
Did you perform any safety
sensitive functions atthis
truck school, regulated by
DOT, and subject to drug
and alcohol testing?
10-1998
12-1998
EW Wylie
Fargo, ND
United States
Yes
Yes
Yes
Areas Driven
Miles driven weekly
Pay Range(cents/mile)
Most commontruck
driven
Most commontrailer
Trailer length
Demorest contracting
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Wereyou
terminated/discharged/laid
off?
lsthis your current
employer?
May we contact this
employer atthis time?
Did you operate a
commercial motor vehicle?
Demorest contracting
07-2007
06-2013
3002nd st w
Carpio, ND58718
United States
Owner
Hurt
No
No
Yes
No
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job,regulated by D0T, and
subject to drug and alcohol
testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most commontruck
driven
Most commontrailer
Trailer length
Kelly inn
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Wereyou
terminated/discharged/laid
off?
Is this your current
employer?
May we contact this
employer atthis time?
Did you operate a
commercial motor vehicle?
North Dakota
3000-3500
Tractor-Trailer
Other
45to 52feet
Kelly inn
07-2013
06-2014
Bismarck,ND 58501
United States
Better job
No
No
Yes
No
Were yousubject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job,regulated by D0T, and
subject todrug and alcohol
testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most commontruck
driven
Most commontrailer
Trailer length
HansonsExcavating
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Were you
terminated/discharged/laid
off?
Termination Explanation
Isthisyourcurrent
employer?
May we contact this
employer atthis time?
Did you operate a
commercial motor vehicle?
Hansons Excavating
07-2014
01-2016
Des Lacs, ND
United States
Laid off
Yes
Seasonal
No
Yes
Yes
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job,requlated by DOT, and
subject todrug and alcohol
testing?
Yes
Yes
* * * * * * * * * * * * * * * * * s e e s * * * * * * . Trailer length
Unemployment
Start Date
End Date
Comment
Dannys classic cars
PLEASE DO NOT CONTACT
Company
Start Date
End Date
Address
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Were you
terminated/discharged/laid
off?
Termination Explanation
Is this your current
employer?
May we contact this
employer at this time?
Did you operate a
commercial motor vehicle?
53feet ormore
07-2017
07-2017
Looking for ajob now
Dannys classic cars
02-2016
06-2017
Elko, SC 29826
United States
Not liking job
Yes
Unknown
Yes
No
No
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did you perform any safety
sensitive functions in this
job, regulated by DOT, and
subject todrug and alcohol
testing?
Trailer length
Dart Transit
Company
Start Date
End Date
Address
City,State/Province
Zip/Postal
Country
Phone
Fax
Position Held
Reason for leaving?
e . * * * * * * . . .
Were you
terminated/discharged/laid
off?
Is this your current
employer?
May we contact this
employer at this time?
Did you operate a
commercial motor vehicle?
53feet ormore
Dart Transit
08-2017
03-2023
850lone oak rd
Eagan, MN
United States
Driver
Lite fraght
No
Yes
Yes
Yes
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
this employer/contractor?
Did youperform any safety
sensitive functions in this
job, regulated by DOT,and
subject todrug and alcohol
testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck
driven
Most common trailer
Yes
Yes
Ga la power lane
* * * * * * * *
2000-2500
Tractor-Trailer
Van
Company
Start Date
End Date
Address
* * * * * * * * * * *
City, State/Province
Zip/Postal
Country
Phone
Position Held
Reason for leaving?
Wereyou
terminated/discharged/laid
off?
lsthis your current
employer?
May we contact this
employer at this time?
Did youoperate a
commercialmotor vehicle?
TRC Freight Inc
03-2023
06-2024
5901 Shallowford Road
#148
Chattanooga, TN 37421
United States
Driver
Truck blown engine
No
Yes
Yes
Yes
Were you subject to the
Federal Motor Carrier or
Transport Canada Safety
Regulations while
employed/contracted by
thisemployer/contractor?
Did you perform any safety
sensitive functions in this
job, regulated by D0T, and
subject to drug and alcohol
testing?
Areas Driven
Miles driven weekly
Pay Range(cents/mile)
Mostcommon truck
driven
Mostcommon trailer
Yes
Yes
48 state
2500-3000
88 Percent upload
Tractor-Trailer
Van
Name
Residence3years or
longer (If No,
previous addresses
shown below)
Current Address
City, State/Province
Zip/Postal
Country
Addresses Over last
3years
Stephen Ray Demorest
No
13535 Ga Hwy 305
Keysville, GA 30816
United States
Address 1
13535 Ga Hwy 305
Keysville,GA 30816
United States
09-2010to 06-2024
SSN/SIN
Date of Birth
Primary Phone
CellPhone
* * * * *
What typeof
position are you
seeking?
***-**-****
04-05-1974
***************@*******.***
Company Driver
Licenses
Please provide all licenses you have held within the last 3years.
License Number 057555041
Licensing Authority GA
Country US
License Class Class A
e * * * * * * * * * * * .
License Expiration Date 04-05-2029
DOT Medical Card 07-17-2025
Expiration Date
Current License Yes
Commercial Driver Yes
License
Endorsements None