Online Driver Application

  First:        

  Middle :    

  Street : 

City :   

State :   - AI AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN KS KY LA ME MD MA MI MN MS MO MT NB NH NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY         Zip :

     (xxx-xx-xxxx)

Other Number :  

Pager Number:   

License #:

State:       AI AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN KS KY LA ME MD MA MI MN MS MO MT NB NH NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY  

Expiration:

BirthDate: 

Current License CDL Class A:           YES NO

Combo vehicles over 26,001  lbs.:    YES NO

Hazardous Materials:                      YES NO

# accidents in the past 5 years?     

# tickets     in the past 5 years?       

Company Name:  

Address:             

City:                   

State:                    AI AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN KS KY LA ME MD MA MI MN MS MO MT NB NH NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code:  

Dates of Employment: From: To:

Phone Number:   

Supervisor:         

Type of Equipment Operated:

# of States:                     Rate of Pay

Company Name:  

Address:             

City:                   

State:                  AI AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN KS KY LA ME MD MA MI MN MS MO MT NB NH NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code:  

Dates of Employment: From: To:

Phone Number:   

Supervisor:         

Type of Equipment Operated:

# of States:                     Rate of Pay

Previous Employer:
 

Company Name:  

Address:              

City:                     

State:                    AI AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN KS KY LA ME MD MA MI MN MS MO MT NB NH NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code:  

Dates of Employment: From:   To:

Phone Number:   

Supervisor:        

Type of Equipment Operated:

# of States:                       Rate of Pay

I certify that I have read and understood all of this employment application. It is agreed and understood that the Employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability and damages on account of furnishing such information. I understand that, as an application for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and a drug test.

I further certify that I am a genuine application for employment and that this application is submitted solely for the purpose of seeking employment with the employer and no other reason.

It is agreed and understood that under the fair credit reporting act, Public Law 91-508, I have been told that this investigation may include and investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired I agree to abide by all the rules and policies of the employer.

This is to certify that this application was completed by me and all the entries on it and the information in it is true and complete to the best of my knowledge.