Personal Info

*If at current address less than 3 years, list below most recent addresses for the past 3 years:

Commercial Driver's License

CDL Type *
Endorsements (check all that apply)
Air Brake Restriction? *
Automatic Transmission Restriction?
Current DOT Medical Card *

Driving/Hauling Years of Experience

Education

High School

College

Trade or Business School

Additional Licenses

List ALL additional licenses held in the past 3 years. DO NOT enter current license information in this section.
Has any license, permit, or privilege ever been suspended, revoked, or denied? *
Have you ever been convicted for driving under the influence of drugs or alcohol? *
Have you ever tested positive or refused to test on any pre-employment drug and / or alcohol test administered by an employer to which you applied for but did not obtain safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years? *
Have you ever been convicted of a felony or misdemeanor? *

Accident Review for Past 3 Years

If no Accidents to report, you must check this box.

Traffic Convictions & Forfeitures for Past 3 Years

If no Traffic Convictions or Forfeitures to report, you must check this box.

Employment History

Most Recent Employer

Driving/Hauling Experience With This Employer
Were you subject to the FMCSRs while employed by this employer? *
Was your job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40? *

2nd Most Recent Employer

Driving/Hauling Experience With This Employer
Were you subject to the FMCSRs while employed by this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?

3rd Most Recent Employer

Driving/Hauling Experience With This Employer
Were you subject to the FMCSRs while employed by this employer?
Was your job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?

May we contact current employer?

Authorization

By clicking "Send" below, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, any falsified statements on this application shall be grounds for dismissal. Under the provisions of the Fair Credit Reporting Act, the Americans With Disabilities Act, the Drivers Privacy Protection Act and all other applicable federal, state, and local laws I authorize investigation of all statements contained herein as well as authorize the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise.

I hereby release and hold harmless any person, firm, or entity that discloses information in accordance with this authorization, as well as my prospective employer, and its agents, from any liability that may otherwise result from the request for, use of, or disclosure of, any or all of the foregoing information. The above-mentioned investigations may include, but are not limited to, information as to my character, general reputation, work history, or lifestyle, discerned through employment and education verifications; personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history records; or any other public record.

I understand that consumer reports which may contain public record information may be requested, at the discretion of my prospective employer, which may include names, dates of employment, reason for termination, work experience, traffic records, workers compensation claims, etc. I have the right, under the provisions of the Fair Credit Reporting Act and the Drivers Privacy Protection Act to request all such information from the reporting agency, upon proper identification, and to request the nature and substance of all information; and the receipt of any reports on me, which the reporting agency has, or will, furnish for the two preceding years. I am also entitled to a copy of my consumer rights under the Fair Credit Reporting Act. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.

I hereby agree and consent to completing this application and background investigation process electronically. I understand that I will be signing this application and all forms related to this application electronically and that the electronic signatures appearing on these documents are the same as my handwritten signature for the purposes of validity, enforceability and admissibility. You have the right to withdraw your consent to sign electronically at any time by calling the number listed at the top of this page. You can print and retain a copy of any electronically signed documents by clicking on the PDF symbol in the top right corner of that document.

This certifies that this application was completed by me and that all entries and the information herein are true and complete to the best of my knowledge.

Once you complete your application and are ready to submit it, please click "Submit Application". You will not be able to make any further edits once you click send.