Driver Application

General Information

Full Name   Birth Date  

Address   

City             State   Zip   Phone 

Current Class ACDL LIC.# State   S.S.#

Personal Reference Phone #  

License Ever Suspended?  Yes No   Reason

Yrs. of Exp.    List states that you have operated in

Any accidents in the past 5 years?  Yes No If yes, how many?

Explain

Have you ever attended a truck driving school?  Yes No Graduation Date

School name & location

Have you ever abandoned a truck?  Yes No

Moving violations in past 5 years?

Would being away from home and on the road 12 to 14 days be a problem?  Yes No

Would driving to the east of west coast be a problem?  Yes No

Any felony convictions?  Yes No

Who referred you?

Past Employment Information

Employer1

Emp Name   

Address       

City               State   Zip

Contact Person   Phone

Employment Dates-  From: Mo. Yr.    To: Mo. Yr.

Position Held

Salary/Wage 

Reason for leaving

Any winter driving experience with this co.?  Yes No

Any mountain driving experience with this co.?  Yes No

Employer2

Emp Name   

Address       

City               State   Zip

Contact Person   Phone

Employment Dates-  From: Mo. Yr.    To: Mo. Yr.

Position Held

Salary/Wage 

Reason for leaving

Any winter driving experience with this co.?  Yes No

Any mountain driving experience with this co.?  Yes No

Employer3

Emp Name   

Address       

City               State   Zip

Contact Person   Phone

Employment Dates-  From: Mo. Yr.    To: Mo. Yr.

Position Held

Salary/Wage 

Reason for leaving

Any winter driving experience with this co.?  Yes No

Any mountain driving experience with this co.?  Yes No

Employer4

Emp Name   

Address       

City               State   Zip

Contact Person   Phone

Employment Dates-  From: Mo. Yr.    To: Mo. Yr.

Position Held

Salary/Wage 

Reason for leaving

Any winter driving experience with this co.?  Yes No

Any mountain driving experience with this co.?  Yes No

By clicking "submit" below you agree to the following:

The information given by me in this application is true and complete in all respects, and I agree that if the information is found to be false, misleading or unsatisfactory in any respect (in the exclusive judgment of the company) that I will be disqualified from consideration for employment or subject to immediate dismissal if discovered after I have been hired.

I understand that the information in the application will be used and that prior positions will be contacted for the purposes of investigation required by 391-23 of the Motor Carrier Safety Regulations.  I authorize release of any information related to my alcohol and controlled substances testing and training records, by any former employers and hold them harmless of any liability from release of said information.