(1) Any person who applies for employment as a driver of a commercial motor vehicle shall provide every prospective employer, at the time of application, with the following information for the ten-year period preceding the date of application:
(a) A list of the names and addresses of the applicant's previous employers for whom the applicant was a driver of a commercial motor vehicle;
(b) The dates the applicant was employed by each employer; and
(c) The reason for leaving that employment.
(2) The applicant shall certify that all information furnished is true and complete. An employer may require an applicant to provide additional information. Any person who fails to provide the information required by this section shall, upon conviction, be guilty of a Class III misdemeanor.