Employee Application

General Information

First Name: *

Last Name: *

Address: *

Apt | Suite:

City:

State/Province:
Select State ALBERTA ALASKA ALABAMA ARKANSAS AMERICAN SAMOA ARIZONA BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA GUAM HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS WINNIPEG MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA MEXICO NEW BRUNSWICK NORTH CAROLINA NORTH DAKOTA NEBRASKA NEWFOUNDLAND NEW HAMPSHIRE NEW JERSEY NEW MEXICO NOVA-SCOTIA NEVADA NEW YORK OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDWARD ISLAND PUERTO RICO QUEBEC DOMINICAN REPUBLIC RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA SASKATCHEWAN TENNESSEE TEXAS UTAH VIRGINIA VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING

Zip:

Email: *

Phone: *

Mobile: *

When can you start?: (MM/DD/YYYY)

Personal Information

Citizenship: *
Select Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarussia Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canton and Enderbury Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Democratic Yemen Denmark Djibouti Dominica Dominican Republic Dronning Maud Land East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France " France',' Metropolitan" French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bisseu Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran(Islamic Republic of) Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Johnston Island Jordan Kazakstan Kenya Kiribati Korea Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands " Moldova',' Republic of" Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Calidonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pacific Islands Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda S. Georgia and S. Sandwich Isls. Saint Lucia Saint Vincent/Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Kitts Nevis Anguilla St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syran Arab Republic Taiwan Tajikistan " Tanzania',' United Republic of " Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Pacific Islands Upper Volta Uruguay Uzbekistan Vanuatu Vatican City State Venezuela VietNam Wake Island Wallis and Futuma Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

CDL Information Your CDL type must be CLASS A

CDL Number: *

CDL State: *
Select State ALBERTA ALASKA ALABAMA ARKANSAS AMERICAN SAMOA ARIZONA BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA GUAM HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS WINNIPEG MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA MEXICO NEW BRUNSWICK NORTH CAROLINA NORTH DAKOTA NEBRASKA NEWFOUNDLAND NEW HAMPSHIRE NEW JERSEY NEW MEXICO NOVA-SCOTIA NEVADA NEW YORK OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDWARD ISLAND PUERTO RICO QUEBEC DOMINICAN REPUBLIC RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA SASKATCHEWAN TENNESSEE TEXAS UTAH VIRGINIA VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING

CDL Expiration: (MM/DD/YYYY)

Previous CDL?:
Select Yes No

Previous CDL number:

Previous CDL state:
Select State ALBERTA ALASKA ALABAMA ARKANSAS AMERICAN SAMOA ARIZONA BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA GUAM HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS WINNIPEG MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA MEXICO NEW BRUNSWICK NORTH CAROLINA NORTH DAKOTA NEBRASKA NEWFOUNDLAND NEW HAMPSHIRE NEW JERSEY NEW MEXICO NOVA-SCOTIA NEVADA NEW YORK OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDWARD ISLAND PUERTO RICO QUEBEC DOMINICAN REPUBLIC RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA SASKATCHEWAN TENNESSEE TEXAS UTAH VIRGINIA VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING

Endorsements

Hazmat endorsement?
Select Yes No

Doubles / triples endorsement?
Select Yes No

Tanker endorsement?
Select Yes No

Passenger endorsement?:
Select Yes No

Driver Preferences

What type of driver are you?
Select Solo Team

What is your working preference?
Select Solo Team

Team member's name:

DMV Record

Driving experience:
Select <12 months 1 year 2 years 3-5 years more than 5 years

Number of moving violations in the last 3 years:

Number of preventable accidents in the last 3 years:

Has your license been suspended or revoked? *
Select Yes No

Have you ever received a DWI / DUI? *
Select Yes No

Have you ever been convicted of a felony? *
Select Yes No

Present or Most Recent Employer

Employed from: (MM/YYYY)

Employed to: (MM/YYYY)

Employer Company Name:

Contact Name:

Address:

City:

State/Province:
Select State ALBERTA ALASKA ALABAMA ARKANSAS AMERICAN SAMOA ARIZONA BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA GUAM HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS WINNIPEG MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA MEXICO NEW BRUNSWICK NORTH CAROLINA NORTH DAKOTA NEBRASKA NEWFOUNDLAND NEW HAMPSHIRE NEW JERSEY NEW MEXICO NOVA-SCOTIA NEVADA NEW YORK OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDWARD ISLAND PUERTO RICO QUEBEC DOMINICAN REPUBLIC RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA SASKATCHEWAN TENNESSEE TEXAS UTAH VIRGINIA VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING

Zip:

Phone number:

Position:

Trailer pulled:

Length of trailer pulled:

How many states ran?:

Did you keep logs?:
Select Yes No

Comments:

Most Recent Past Employer

Employed from: (MM/YYYY)

Employed to: (MM/YYYY)

Employer Company Name:

Contact Name:

Address:

City:

State/Province:
Select State ALBERTA ALASKA ALABAMA ARKANSAS AMERICAN SAMOA ARIZONA BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA GUAM HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS WINNIPEG MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA MEXICO NEW BRUNSWICK NORTH CAROLINA NORTH DAKOTA NEBRASKA NEWFOUNDLAND NEW HAMPSHIRE NEW JERSEY NEW MEXICO NOVA-SCOTIA NEVADA NEW YORK OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDWARD ISLAND PUERTO RICO QUEBEC DOMINICAN REPUBLIC RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA SASKATCHEWAN TENNESSEE TEXAS UTAH VIRGINIA VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING

Zip:

Phone number:

Position:

Trailer pulled:

Length of trailer pulled:

How many states ran?:

Did you keep logs?:
Select Yes No

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.