Personal Information
Are you legally permitted to work in the United States? * Yes No
Position Applying for: * Company Driver Owner Operator other
How did you hear about our company? * Indeed Craigslist Zip Recruiter Truck Driver Jobs CDL Life Simply Hired other
Full Name: *
Current Address: *
Email Address: *
Social Security No.: *
Date of Birth: *
Phone Number: *
Have you resided at the above address for more than three years? * Yes No
How soon are you available for work? *
Can you work nights? Yes No
Are you available for on-call work? Yes No
Desired position frame: Full-Time Part-Time
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License and Driving Information
License Number: *
Date of Expiration: *
State where the license was issued: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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
Type of License: * Commercial Non-Commercial
Class of License: * Class A Class B Class C
Endorsements: * H – Hazardous Materials (HazMat) N – Tank Vehicles P – Passenger Transport S – School Bus T – Double/Triple Trailers X – Combination of Tanker & HazMat F – Farm Vehicles
Do you possess a valid TWIC card? * Yes No
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? * Yes No
Have you ever had any license, permit, or privilege suspended or revoked? * Yes No
Have you previously held a driver's license in any other state? * Yes No
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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
Do you own a commercial vehicle? * Yes No
Are you able to perform the essential job functions with or without reasonable accommodations? * With Reasonable Accommodations No Accommodations Needed
Hiring classification: * Direct Hire Contractor Temporary
Have you ever been convicted of a crime? * Yes No
Have you been convicted of DUI within the last 10 years? * Yes No
Have you had any accidents within the past three years? * Yes No
Have you had any moving violations in the past three years? * Yes No
Other than parking tickets, have you had any traffic-related convictions or forfeitures in the last 3 years? * Yes No
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Employment History
Name of Employer: *
Are you currently employed with this company * Yes No
Name of Supervisor: *
Phone Number: *
Address: *
Employment Dates From: *
Employment Dates To: *
Job Title: *
List the position you held, duties performed, skills used or learned, promotions: *
Was this position subject to FMCSA regulations? * Yes No
May we contact this employer? Yes No
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