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DRIVER APPLICATION
Please fill out the form below and click the submit button.

MUST BE A U.S. RESIDENT
All Fields with an asterisk (*) are required.
CONTACT INFORMATION:
* Full Name
 *Street Address
*City
 *State
*Zip/Postal Code
 *Cell Phone
*Night Phone
 E-mail
*Date of Birth
 *Social Security #
*Best Time to Call
  
DRIVING INFORMATION:
CURRENT DRIVER LICENSE INFORMATION (license required unless a student):
License Number
 Class:
 
Class A Class B Class C
State                                  Expiration Date
 
    		Endorsements:
 
Hazmat Double/Triple Tanker
Experience (Miles /Years):

Have you completed truck driving course Yes   |   No Date

EMPLOYMENT INFORMATION:
CURRENT EMPLOYER:

 		Street / City / State / Zip:
Starting Date:

 		Phone Number:

PAST EMPLOYER 1:

 		Street / City / State / Zip:
Starting Date:

 		Ending Date:

 		Phone Number:

PAST EMPLOYER 2:

 		Street / City / State / Zip:
Starting Date:

 		Ending Date:

 		Phone Number:

PAST EMPLOYER 3:

 		Street / City / State / Zip:
Starting Date:

 		Ending Date:

 		Phone Number:
Additional Comments:

EDUCATION:
Highest level of education: Additional Education:

 

CRIMINAL RECORD (if any):
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes | No   Date:
Has any license, permit or privilege ever been suspended or revoked? Yes | No   Date:
Been disqualified from driving a motor vehicle under DOT regulations? Yes | No   Date:
Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes | No   Date:
Have you ever been convicted, or are any charges pending, for reckless or careless operation of a motor vehicle? Yes | No   Date:

Give list of all traffic offences and accidents for the preceding 3 years of date of application.:
It is agreed and understood that any misrepresentation given on this application shall be considered anact of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’sbackground to ascertain any and all information of concern to applicant’s record, whether same is ofrecord or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.It is also agreed and understood that under the Fair Credit Reporting Act, Public law 91-508, I havebeen told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and ode of living.I agree to furnish such additional information and complete such examinations as may be required tocomplete my application file. It Is agreed and understood that this Application for Qualification in no way obligates the motorcarrier to employ or hire the applicant.It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.This certifies that this application was completed by me, and that all entries on it and information init are true and complete to the best of my knowledge.

I have read the above release.

Yes   |   No