Please check the required fields

1. ---

   Personal Information and Contact
2. Full Name *
3. Street Address *
4. City *
5. State *
   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
6. Zip/Postal Code *
7. Day Phone *
8. Evening Phone  
9. Best time to call *
10. Date of Birth *
    (mm/dd/yy)
11. Social Security Number *
12. E-mail Address *

13. ---

    Current License
14. License Number  
15. State  
    Choice 1 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 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 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
16. Expire Date  
    MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
17. Class  
    A
    B
    C
    
18. Endorsements  
    Hazmat
    Double / Triple
    Tanker
    

19. ---

    Driving History Information:
20. Years of tractor trailer driving experience? *
21. You are currently a(n) *
    Owner Operator
    Company Driver
    Student
    
22. How many trucks do you own?  
23. You would like to run  
    Single
    Team
    Husband/Wife
    
24. Number of Accidents  
    (past 3 years)
25. Moving Violations  
    (past 3 years)
26. Experience if not a student  
    HHG
    Van
    Auto Carrier
    Tanker
    Reefer
    Hazmat
    Flatbed
    Specialized
    Double/Triple
    
27. Freight Type you prefer to pull  
    HHG
    Van
    Auto Carrier
    Tanker
    Reeler
    Hazmat
    Flatbed
    Specialized
    Double/Triple
    
28. Regions you prefer to run  
    Southeast
    Southwest
    Midwest
    Northeast
    Northwest
    Local
    
29. Interested in lease/purchase  
    Yes
    No
    maybe
    

30. ---

    Additional comments to tell recruiters
31. Your comment  

32. ---

    Criminal Record (if any)
33. Do you have any felony convictions on your record?  
    Yes
    No
    
34. Date  
35. Do you have any pending charges or convictions for driving under the influence?  
    Yes
    No
    
36. If so have you had more than one?  
    Yes
    No
    
37. Date of most recent DWI/DUI?  
38. Has your license or privilege to operate a motor vehicle ever been denied? *
    Yes
    No
    
39. Date  
40. Do you have any license or permit suspensions on your record?  
    Yes
    No
    
41. Date  
42. Do you have any charges pending or have you ever been convicted for reckless or careless operation of a motor vehicle?  
    Yes
    No
    
43. Date  
44. Do you have any charges pending for, or have you ever been convicted of possession, sale, or use of drugs?  
    Yes
    No
    
45. Date  
46. Have you ever been refused any type of insurance or been denied bonding?  
    Yes
    No
    
47. Date  
48. Have you ever been discharged or suspended?  
    Yes
    No
    
49. Date  

50. ---

    Employment Information
51. Current Company Name  
52. Street/City/State/Zip:  
53. Starting Date:  
54. Phone Number  
55. Reason for Leaving:  
56. Past Company Name: 1 *
57. Street/City/State/Zip:  
58. Starting Date:  
59. Ending Date:  
60. Phone Number  
61. Reason for Leaving:  
62. Past Company Name: 2  
63. Street/City/State/Zip:  
64. Starting Date:  
65. Ending Date:  
66. Phone Number  
67. Reason for Leaving:  
68. Past Company Name: 3  
69. Street/City/State/Zip:  
70. Starting Date:  
71. Ending Date:  
72. Phone Number  
73. Reason for Leaving:  
74. Past Company Name: 4  
75. Street/City/State/Zip:  
76. Starting Date:  
77. Ending Date:  
78. Phone Number  
79. Reason for Leaving  

80. ---

    Application Disclaimer
81. I have read and agree with the terms, conditions and use of information I am providing and I give permission to obtain consumer reports about me from DAC. *
    Yes
    No
    
82. Security Code: *
    Reload Image
    
83.  
    

 

 

• Interstate Dist. Co.
• Baldwin Distribution
• Bay and Bay Transportation
• Clark Transfer
• Combined Transport Inc.
• CT Transportation
• CTL Transportation
• CCC Transportation
• Freight Exchange F/X
• Gordon Trucking Inc. GTI
• Great Wide
• HeartLand Express
• Henderson Trucking
• Pride Transport
• Metropolitan Trucking, Inc.
• TMC Transportation
• Transport America

 

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