Truck Driver Application

Elliott's Greenhead Recycle
You are applying for a driving job with Elliott's Greenhead Recycle. Thank for allowing us to help you with your career search!
Position/Lane Applying For
General Information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YesNo
Please list prior 3 year addresses here and please be complete
Social Security Number*
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
E-mail*
YesNo
Please list name
Explain ie; maiden name, name change
YesNo
YesNo
License Information
YesNo
License Class*
License Number*
State of Issue*
License expiration date*

MonthDayYear
Expiration date of DOT physical card

MonthDayYear
NoneTankerDoubles/TriplesHazmatX EndorsementTWIC
Hazmat expiration date

MonthDayYear
TWIC expiration date

MonthDayYear
Please list any licenses held in other states for the previous 5 years, include license numbers if you can.
YesNo
Branch of service
Please list Dates of enlisment
Enlist date - Discharge date
YesNoOther
YesNoI can obtain one
YesNo
School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry
School phone number

Area CodePhone Number
YesNo
EMPLOYMENT HISTORY
Work History: Please list current, or most recent employment first
Start date*

MonthDayYear
Ending date*

MonthDayYear
Employer Name*
City, State*
Employer phone*

Area CodePhone Number
Position Held*
Reason for leaving*
YesNo
YesNo
YesNo
Type of truck
Type of trailer
Trailer length
Number of states driven
NEXT EMPLOYER
Start date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Position Held
Reason for leaving
Employer phone

Area CodePhone Number
YesNo
Type of truck
Type of trailer
Trailer length
Number of states driven
NEXT EMPLOYER
Starting date

MonthDayYear
Ending date

MonthDayYear
Employer Name
City, State
Position Held
Employer phone

Area CodePhone Number
Reason for leaving
YesNo
Type of truck driven
Type of trailer
Trailer length
Number of states driven
Start Date

MonthDayYear
End Date

MonthDayYear
Employer Name
City and State
Position
Employer Phone

Area CodePhone Number
Reason for leaving
YesNo
Type of truck driven
Type of trailer
Trailer length
Number of states driven
If you need additional space for past employment, please enter it here and include ALL information previously asked for.
Additional Information
YesNo
If yes, please list City, County and State, month, year and nature of offense and any fines involved
Please list miles over limit for speeding
YesNo
If yes, please give date and length of supension. List reason why, city, county and state
List all details asked for
YesNo
If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)
YesNo
If yes, please list date of offense, jail time, fine and or suspension time.
We must have complete information to satisfy isusance carrier requirements.
YesNo
If yes, please give date and nature of offense, city, county, state and any fines and time served
Please list EVERYTHING asked for per isurance requirements
YesNo
If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines
Please list EVERYTHING asked for
Additional Information
References: Please list name, address, phone and years known.
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Number of years known
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Number of years known
Emergency contact information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship to you*
Phone Number*

Area CodePhone Number
HIGH SCHOOL
Name & City/State of High School
YesNo
By signing I agree I have read the above statements
Should be Empty:

General Information

License Information

EMPLOYMENT HISTORY

Additional Information

Additional Information

References: Please list name, address, phone and years known.

Emergency contact information