Truck Driver Application

Personal Information

First Name:
Middle Name:
Last Name:
Street Address:
City:
Select State:
–Select– AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip:
Date of Birth:
SSN:
Telephone:
Previous Addresses (last 3 years):

Driver Licenses

License State 1: –Select– AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
License No. 1:
Type 1:
Expiration Date 1:
License State 2: –Select– AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
License No. 2:
Type 2:
Expiration Date 2:

Driving Experience

Straight Truck – Type of Equipment:
Straight Truck – Dates From: To:
Straight Truck – Approx. No. of Miles:
Tractor & Semi-Trailer – Type of Equipment:
Tractor & Semi-Trailer – Dates From: To:
Tractor & Semi-Trailer – Approx. No. of Miles:
Other Equipment – Type:
Other Equipment – Dates From: To:
Other Equipment – Approx. No. of Miles:

Accident Record (last 3 years)

Last Accident – Date:
Last Accident – Nature:
Last Accident – Fatalities: Last Accident – Injuries:

Traffic Convictions (last 3 years)

Conviction 1 – Location: Date: Charge: Penalty:

Disclosures

Felony, DUI or DWI Conviction? Yes No
If yes, please explain:

License suspended/revoked? Yes No
If yes, please explain:

Tested positive for drugs/alcohol? Yes No
If yes, please explain:

Employment Experience

Employer 1

City/State

Job Title

Supervisor

Dates Employed From

Dates Employed To

Work Performed

Reason for Leaving

Employer 2

City/State

Job Title

Supervisor

Dates Employed From

Dates Employed To

Work Performed

Reason for Leaving

Employer 3

City/State

Job Title

Supervisor

Dates Employed From

Dates Employed To

Work Performed

Reason for Leaving

Equipment Experience

Dump Trailer Experience? Yes No Approx. Miles:
Low Boy Trailer Experience? Yes No Approx. Miles:
Flat Trailer Experience? Yes No Approx. Miles:

References

Reference 1 Name

Reference 1 Address

Reference 1 Phone

Reference 2 Name

Reference 2 Address

Reference 2 Phone

Reference 3 Name

Reference 3 Address

Reference 3 Phone

Additional Questions

Are you on lay-off and subject to recall? Yes No
Can you travel if a job requires it? Yes No
Friends or relatives work here? Yes No
If yes, list names:
Starting Wage/Salary You Expect:

Voluntary Questions

Age:
Sex:
Marital Status:
Number of Dependents and Ages:
Family Plans:
Do you smoke?:
Do you abuse drugs or alcohol? Yes No

Certification

Applicant Signature:
Date Signed:

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