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Application
Suffix
Mr.
Mrs.
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First Name
Last Name
Address
City
State
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Zip
Phone#
-
-
Alt/Cell Phone#
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E-mail
Do you have your CDL?
yes
no
what type of driver are you?
COMPANY DRIVER
OWNER OPERATOR
STUDENT DRIVER
We have carriers across the US that need drivers now. Take just a minute to provide the information they need to offer you the job you deserve.
Birth Date
January
February
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Commercial Driver's License Information
DL #:
Expiration:
January
February
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2008
2009
2010
2011
2012
2013
2014
2015
State of Issue:
choose state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
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Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
School Information
Have you attended driving school?
Yes
No
If so, what school did you attend?
If so, supply date you graduated?
January
February
March
April
May
June
July
August
September
October
November
December
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General Information
Years of truck driving experience?
under 1 year
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29
30 or more
Working Preference
Single Driver
Team Driver
Team, Husband / Wife
Preferred Position
Over The Road
Local
Regional
Desired number of miles per week
less than 1500
1500 - 2000
2000 - 2500
2500 - 3000
more than 3000
Do you have Hazmat endorsement?
Yes
No
Do you have Tanker endorsement?
Yes
No
Do you have Double/Triple endorsement?
Yes
No
What is your trailer experience.(Check all that apply)
Tanker
Van
Flatbed
Double/Triple
Specialized
Household Goods
Refrigerated
Agriculture
Car Hauler
Expedited
What equipment do you prefer to work on.(Check all that apply)
Tanker
Van
Flatbed
Double/Triple
Specialized
Household Goods
Refrigerated
Agriculture
Car Hauler
Expedited
Preferred traffic lanes (Check all that apply)
North West
South West
North Central
South Central
North East
South East
Lower 48 States
Owner-Operator Tractor Information
Do you currently own/lease a tractor?
Yes
No
If not, Would you be interested in a lease/purchase program?
Yes
No
Year
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
Make
Engine
Mileage
0-199k
200-399k
400-599k
600-799k
800-999k
Number of tickets/citations received in the last 5 years?
0
1
2
3
4
5
6
7
8
9
10
11
12
Number of accidents in the last five years, if any?
0
1
2
3
4
5
6
7
8
9
10
11
12
Have you ever received a DUI/DWI?
Yes
No
Has your license ever been suspended?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Present/Last Employer
Dates of employment?
FROM
January
February
March
April
May
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1991
1990
1989
1988
TO
January
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1992
1991
1990
1989
1988
Employer:
Address:
City:
State:
choose state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Phone:
-
-
Position:
Reason for leaving:
May we contact this employer?
Yes
No
Previous Employer 1
Dates of employment?
FROM
January
February
March
April
May
June
July
August
September
October
November
December
1
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1991
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1989
1988
TO
January
February
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1998
1997
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1995
1994
1993
1992
1991
1990
1989
1988
Employer:
Address:
City:
State:
choose state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Phone:
-
-
Position:
Reason for leaving:
May we contact this employer?
Yes
No
Previous Employer 2
Dates of employment?
FROM
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
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31
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
TO
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
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10
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2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
Employer:
Address:
City:
State:
choose state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Phone:
-
-
Position:
Reason for leaving:
May we contact this employer?
Yes
No
Your SS# will be needed to run a DAC report. Your SS# will be stored in a secure area and will never be distributed to any persons or companies except qualified carriers recieving your application.
Social Security#
-
-
As part of a carriers consideration of your application, the DOT requires them 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 them 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, they will tell you. They 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.
consent for them to obtain the report from DAC is required. Although you have a right to withhold your consent, they may not consider your application if you do.
I have read the above release and I give permission to obtain consumer reports about me from DAC
I have read the above release and I do NOT give permission to obtain consumer reports about me from DAC