Employee Application

General information

First name * This field is required. Address * This field is required. City This field is required. Zip This field is required. Phone * This field is required. Incorrectly filled out. When can you start? This field is required.

Last name * This field is required. Apt / Suite This field is required. State / Province Email * This field is required. Incorrectly filled out. Mobile * This field is required. Incorrectly filled out.

Personal Information

Citizenship * This field is required.

CDL information your CDL type must be CLASS A

CDL Number * This field is required. CDL Expiration This field is required. Previous CDL Number This field is required.

CDL State * This field is required. Previous CDL? Previous CDL State

Endorsements

Hazmat endorsement? Tanker endorsement?

Doubles / Triples endorsement? Passenger endorsement?

Driver preferences

What type of driver are you? Team member’s name

What is your working preference?

DMV Record

Driving experience Number of preventable accidents (last 3 years) Have you ever received a DWI/DUI? * This field is required.

Number of moving violations (last 3 years) Has your license been suspended or revoked? * This field is required. Have you ever been convicted of a felony? * This field is required.

Present or most recent employer

Employed from Employer company name Address State/Province Phone number Incorrectly filled out. Trailer pulled How many states ran?

Employed to * This field is required. Contact name City Zip Position Length of trailer pulled Did you keep logs?

Comments

Most recent past employer

Employed from Employer company name Address State/Province Phone number Incorrectly filled out. Trailer pulled How many states ran?

Employed to * This field is required. Contact name City Zip Position Length of trailer pulled Did you keep logs?

Comments

Statement of Understanding

I certify that I am authorized to complete this application and that all of the information is true and correct. I authorize represented carriers and their agents to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officers or their agents, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by the above carriers and hold them guiltless of all liability from release of said information. I have read and understand the above statements and acknowledge by affixing my digital signature below.

I have read and understand the above statements I agree The Terms & conditions * This field is required.

First and Last Name * This field is required.

Employee Application

General information

Personal Information

CDL information your CDL type must be CLASS A

Endorsements

Driver preferences

DMV Record

Present or most recent employer

Most recent past employer

Statement of Understanding

Thank You Message