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TRUCK DRIVER APPLICATION
Please fill out the application below in its entirety to be considered for our open position(s).
Step 1 of 5
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Personal Information
Name
*
First
Last
Phone
*
Email
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
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California
Colorado
Connecticut
Delaware
District of Columbia
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Maryland
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Utah
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Have you been at this residence less than three years?
Yes
No
Please list below all residences within the past three years.
Address
*
Street Address
Address Line 2
City
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
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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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Add Another Address
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Add Another Address
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Position you are applying for
*
Type of employment
*
Temporary
Part-Time
Full-Time
Who referred you?
Expected rate of pay
Have you worked for this company before?
*
No
Yes
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Position
*
Rate of pay
*
Reason for leaving
*
Names of any relatives employed by this company
Are you currently employed?
*
Yes
No
How long since leaving last employment?
*
Education
Highest degree completed
*
High School
Associate Degree
Bachelor's Degree
Graduate or Professional Degree
Some College
Other
Last school attended
*
School location
*
General Information
Have you ever been bonded?
Yes
No
Name of bonding company
*
Have you ever worked for this company under another name?
Yes
No
What name?
*
Driver Experience & Qualification
Licenses
Licenses held in the past 3 years must be shown.
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
License Number
*
Class
*
Endorsments
Expiration Date
*
MM
DD
YYYY
Add another license
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
License Number
*
Class
*
Endorsments
Expiration Date
*
MM
DD
YYYY
Add another license
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
License Number
*
Class
*
Endorsments
Expiration Date
*
MM
DD
YYYY
Add another license
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
License Number
*
Class
*
Endorsments
Expiration Date
*
MM
DD
YYYY
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
*
Yes
No
Please provide details
*
Has any license, permit or privilege ever been suspended or revoked?
*
Yes
No
Please provide details
*
Driving Experience
Check yes or no for each type of equipment.
Straight Truck
*
Yes
No
Type of equipment
*
Check all that apply
Van
Tank
Flat
Dump
Refer
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Tractor & Semi-Trailer
*
Yes
No
Type of equipment
*
Check all that apply
Van
Tank
Flat
Dump
Refer
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Tractor & Two Trailers
*
Yes
No
Type of equipment
*
Check all that apply
Van
Tank
Flat
Dump
Refer
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Tractor & Three Trailers
*
Yes
No
Type of equipment
*
Check all that apply
Van
Tank
Flat
Dump
Refer
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Motorcoach/School Bus
*
More than 8 passengers
Yes
No
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Motorcoach/School Bus
*
More than 16 passengers
Yes
No
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Approximate number of total miles
*
Select all states operated in during last five years
*
Hold Ctrl to select multiple states
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
Special courses or training that will help you as a driver
Which safe driving awards do you hold and from whom?
Accident Record
Please list all accidents from the past 3 years.
I have not been involved in any accidents within the last three years.
Date of last accident
*
MM
DD
YYYY
Nature of accident
*
Head-on, rear-end, etc.
Fatalaties
*
Injuries
*
Hazardous Material Spill
*
Add another accident
Date of accident
*
MM
DD
YYYY
Nature of accident
*
Head-on, rear-end, etc.
Fatalaties
*
Injuries
*
Hazardous Material Spill
*
Add another accident
Date of accident
*
MM
DD
YYYY
Nature of accident
*
Head-on, rear-end, etc.
Fatalaties
*
Injuries
*
Hazardous Material Spill
*
Traffic Convictions & Forfeitures
List all from the past 3 years, other than parking violations.
I have no traffic convictions or forfeitures within the past 3 years.
Location
*
Date
*
MM
DD
YYYY
Charge
*
Penalty
*
Add another
Location
*
Date
*
MM
DD
YYYY
Charge
*
Penalty
*
Add another
Location
*
Date
*
MM
DD
YYYY
Charge
*
Penalty
*
Employment History
All driver applicants to must provide the following information on all employers during the preceding 3 years: List complete mailing address, street number, city, state and zip code. Applicants must include the names of DOT-regulated employers under whose authority they operated as a contract or leased driver. Applicants to drive a commercial motor vehicle* that requires a CDL in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle, (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
**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 more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
Employer Name
*
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Position Held
*
Salary/Wage
*
Reason for leaving
*
Contact Person
*
Phone
*
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
Add another job
Employer Name
*
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Salary/Wage
*
Position Held
*
Reason for leaving
*
Contact Person
*
Phone
*
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
Add another job
Employer Name
*
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Salary/Wage
*
Position Held
*
Reason for leaving
*
Contact Person
*
Phone
*
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
Add another job
Employer Name
*
Address
*
Street Address
Address Line 2
City
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Salary/Wage
*
Position Held
*
Reason for leaving
*
Contact Person
*
Phone
*
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
Maintenance Experience & Qualifications
List courses and training in maintenance work
One per line
Job Function
Indicate training and experience in the following:
Drive Line Components
Yes, I Have Formal Training
Years of Experience
Diesel Engine Tune-up and Rebuild
Yes, I Have Formal Training
Years of Experience
Gas Engine Tune-up and Rebuild
Yes, I Have Formal Training
Years of Experience
Tire Service
Yes, I Have Formal Training
Years of Experience
Trailer Repair
Yes, I Have Formal Training
Years of Experience
Air Conditioning (Cab)
Yes, I Have Formal Training
Years of Experience
Refrigeration (Cargo)
Yes, I Have Formal Training
Years of Experience
Body Work
Yes, I Have Formal Training
Years of Experience
Elecrical Repair
Yes, I Have Formal Training
Years of Experience
Frame and Wheel Alignment
Yes, I Have Formal Training
Years of Experience
Brakes
Yes, I Have Formal Training
Years of Experience
Cooling System
Yes, I Have Formal Training
Years of Experience
Inspections (State/Federal)
Yes, I Have Formal Training
Years of Experience
General Car Repair
Yes, I Have Formal Training
Years of Experience
Shop Equipment
Indicate training and experience in the following:
Diagnostic Equipment
Yes, I Have Formal Training
Years of Experience
Sheet Metal Equipment
Yes, I Have Formal Training
Years of Experience
Frame & Axle Straightening Equipment
Yes, I Have Formal Training
Years of Experience
Engine Rebuilding
Yes, I Have Formal Training
Years of Experience
Diesel Injection Equipment
Yes, I Have Formal Training
Years of Experience
Electric Welder
Yes, I Have Formal Training
Years of Experience
Oxyacetylene Welder
Yes, I Have Formal Training
Years of Experience
Paint Spray Gun
Yes, I Have Formal Training
Years of Experience
Air Conditioning (Cab)
Yes, I Have Formal Training
Years of Experience
Refrigeration (Cargo)
Yes, I Have Formal Training
Years of Experience
Tire Servicing
Yes, I Have Formal Training
Years of Experience
Wheel & Tire Balancing Machine
Yes, I Have Formal Training
Years of Experience
Tire Recapping
Yes, I Have Formal Training
Years of Experience
Engine Dynamometer
Yes, I Have Formal Training
Years of Experience
Chasis Dynamometer
Yes, I Have Formal Training
Years of Experience
Magnetic Crack Detector
Yes, I Have Formal Training
Years of Experience
Engine Analyzer
Yes, I Have Formal Training
Years of Experience
Noise Measuring Equipment
Yes, I Have Formal Training
Years of Experience
Emissions/Smoke Testing
Yes, I Have Formal Training
Years of Experience
Inspections (State/Federal)
Yes, I Have Formal Training
Years of Experience
General Car Repair
Yes, I Have Formal Training
Years of Experience
ASE Certifications
Please specify, one per line.
Clerical Experience & Qualifications
List courses and training in office work
One per line
Typing
Yes, I Have Formal Training
Years of Experience
Shorthand
Yes, I Have Formal Training
Years of Experience
Billing
Yes, I Have Formal Training
Years of Experience
Filing
Yes, I Have Formal Training
Years of Experience
Computers
Yes, I Have Formal Training
Years of Experience
List software
One per line
Word Processing Equipment
Yes, I Have Formal Training
Years of Experience
Key Punch
Yes, I Have Formal Training
Years of Experience
Calculator
Yes, I Have Formal Training
Years of Experience
Adding Machine
Yes, I Have Formal Training
Years of Experience
Telecopier
Yes, I Have Formal Training
Years of Experience
Photocopier
Yes, I Have Formal Training
Years of Experience
Dictating Machine
Yes, I Have Formal Training
Years of Experience
Bookkeeping Machine
Yes, I Have Formal Training
Years of Experience
Switchboard Equipment
Yes, I Have Formal Training
Years of Experience
Indicate Type
Tabulator
Yes, I Have Formal Training
Years of Experience
Accounting
Yes, I Have Formal Training
Years of Experience
OS & D
Yes, I Have Formal Training
Years of Experience
Interline
Yes, I Have Formal Training
Years of Experience
Claims
Yes, I Have Formal Training
Years of Experience
Cashier
Yes, I Have Formal Training
Years of Experience
Dispatcher
Yes, I Have Formal Training
Years of Experience
Platform Experience & Qualifications
List types of platform experience and number of years each
One per line
List platform equipment you can operate (lift truck, etc)
One per line
List courses or training in platform work
One per line
Applicant Must Read & Sign
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Name
*
First
Last
Date
*
Date Format: MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
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