Company Applying For
How did you hear of our company? If someone referred you, who?
First Name REQUIRED
Last Name REQUIRED
Middle Initial
Home Address REQUIRED
Home City REQUIRED
State REQUIRED
Zip Code REQUIRED
Email Address
Home Phone / - REQUIRED
Cell Phone / -
Pager Phone / -
Date of Birth REQUIRED
Are you a US citizen? Yes No
Do you have the legal right to work in the USA? Yes No
Applying As Driver For
Social Security Number REQUIRED
Do you have your own IRP plate Yes No
CDL Number REQUIRED
State REQUIRED
CDL Expiration Date
Issue Date
Has your CDL ever been revoked? (If Yes Explain Below) Yes No
Have you ever been convicted of a felony? (If Yes explain Below) Yes No
Number of tickets in the last three years (Explain Below)
How many moving violations are on your MVR for the last 3 years?
Number of accidents in the last three years (Explain Below)
If Yes Please Explain.

Endorsements: (check the ones you have) HAZ-MAT      Doubles/Triples          Tanks
Do You Have A Valid Passport? Yes No REQUIRED
Expiration Date 
Years of driving experience
How many years experience do you have with flatbeds?
How many years experience do you have with vans?
Number of licenses held in the last three years
How many tractors do you own?
Tractor Description
How many trailers do you own?
Trailer Description
Do you want long haul or regional freight?
What is your monthly truck payment?
Are you current on your truck payments? Yes No
What is your monthly trailer payment?
Are you current on your trailer payments? Yes No
Present or
Last Employer /
Driver Training
Program
Name REQUIRED
Address REQUIRED
City, State, Zip REQUIRED
Phone(include area code) REQUIRED
From Date  REQUIRED
To Date  REQUIRED
Are you currently working? Yes   No     
 Can we contact your current employer?  Yes   No
Reason for leaving REQUIRED Type of Trailer Pulled REQUIRED
Position held REQUIRED
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason
Next to
Last Employer/
Driver Training
Program
Name
Address
City, State, Zip
Phone (include area code)
From Date 
To Date 
Reason for leaving Type of Trailer Pulled
Position held
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason
Third to
Last Employer/
Driver Training
Program
Name
Address
City, State, Zip
Phone (include area code)
From Date 
To Date 
Reason for leaving Type of Trailer Pulled
Position held
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason
Fourth to
Last Employer/
Driver Training
Program
Name
Address
City, State, Zip
Phone (include area code)
From Date 
To Date 
Reason for leaving Type of Trailer Pulled
Position held
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason
Fifth to
Last Employer/
Driver Training
Program
Name
Address
City, State, Zip
Phone (include area code)
From Date 
To Date 
Reason for leaving Type of Trailer Pulled
Position held
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason
Sixth to
Last Employer/
Driver Training
Program
Name
Address
City, State, Zip
Phone (include area code)
From Date 
To Date 
Reason for leaving Type of Trailer Pulled
Position held
Were you subject to the FMCSRs** while employed? Yes   No     
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes   No     
Account for period between jobs - Include dates (month/year) and reason

Any gaps in employment and/or unemployment must be explained.

** The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring pacarding.

 

Please read the following, sign the box below using a mouse, stylus or finger
and press "I accept" only if you agree.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

"I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history and background as required by 49 CFR 391.23(d) and (e), FMCSR 391.21, 49 CFR 382.405 and CFR 382.413.

•Review information provided by current/previous employers
•Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
•Have a rebuttal statement attached to the alledged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information."

I acknowledge and agree to the above: