MUST BE A U.S. RESIDENT All Fields with an asterick
(*) are required.
Contact and Personal Information:
*Full Name
*Street Address
*City
*State
*Zip/Postal Code
*
Day Phone
*Evening Phone
*
Best Time to Call
*Date of Birth
*
Social Security #
E-mail Address
Current Driver's License Information:
License Number
State
Expiration Date
Class:
Class A
Class B Class C
Endorsements:
Hazmat Double/Triple Tanker
Driving History & Driving Information:
* Years of tractor trailer driving experience:
*
You are currently a(n):
Owner Operator Company Driver
Number of Accidents (past three years)
Traffic Convictions/Violations (past three years, other than parking violations):
Experience:
HHG
Tanker
Flatbed
Van
Reefer
Specialized
Auto Carrier
Hazmat
Double/Triple
Regions you prefer to run (check all that apply):
Southeast
Southwest
Midwest
Northeast
Northwest
Local
Employment Information:
CURRENT EMPLOYER:
Company Name:
Street / City / State / Zip:
Starting Date:
Phone Number:
PAST EMPLOYER 1:
Company Name:
Street / City / State / Zip:
Starting Date:
Ending Date:
Phone Number:
PAST EMPLOYER 2:
Company Name:
Street / City / State / Zip:
Starting Date:
Ending Date:
Phone Number:
PAST EMPLOYER 3:
Company Name:
Street / City / State / Zip:
Starting Date:
Ending Date:
Phone Number:
PAST EMPLOYER 4:
Company Name:
Street / City / State / Zip:
Starting Date:
Ending Date:
Phone Number:
Criminal Record (if any):
Have you ever been convicted of a felony?
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 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:
Have you
ever been convicted, or are any charges pending, for reckless or careless operation of a
motor vehicle?
Yes |
No Date:
Have you ever been
convicted, or are any charges pending, for possession, sale or use of a narcotic drug,
amphetamines, or derivatives thereof?
Yes |
No Date:
Have you ever been refused
any type of insurance or been denied bonding?
Yes |No Date:
Have you ever been discharged
or suspended?
Yes |No Date:
Additional Comments To Tell Recruiters:
Application Disclaimer:
By submitting this application I certify that I personally completed this application and
that all of the information is true and correct. I hereby request and authorize Carrier
Companies and their agents or contractors that receive this application to cause to be
conducted, at any time, an investigation of my background for employment purposes, which may
include, but is not limited to, any information relating to my character, general reputation,
personal characteristics, mode of living, criminal history, past work experience, educational
background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or
any other information about me which may reflect upon my potential for employment gathered from
any individual, organization, entity, agency, or other source which may have knowledge concerning
any such items of information. I have completed this application of my own free will and hold
harmless of all liability all companies, agents and associated parties for the use of this
application. As part of our consideration of your application, the DOT requires companies to
investigate your employment background. As part of this investigation, they may obtain consumer
reports about you from DAC Services. DAC is a consumer reporting agency. Any decision they make
not to hire you based on information contained in your consumer report will be their decision alone.
DAC does not make any decisions concerning your employment with these companies and will not know
the specific reasons why they may decide not to hire you. In the event you are not hired based on
information contained in your consumer report, the companies them selves will tell you. We will
also advise you of your right to obtain a free copy of the consumer report from DAC and your right
to dispute the accuracy or completeness of your report.Your consent for these companies to obtain
the report from DAC is required. Although you have a right to withhold your consent, companies
will not consider your application if you withhold your consent.
I have read the above release and I give
permission to obtain consumer reports about me from DAC.
Yes | No
Please click the Submit button only once and wait just a moment for a confirmation page to
load. Thank you very much for applying.
***We in no way
supplement information from an application submitted to or with any other sources.***
