Lux Express Iogistics

Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number*
Phone number*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

CDL Information
CDL Number*
State*
CDL Expiration Date*

MonthDayYear
Date
Endorsement

TankerHazMatDouble/Triple trailersTWIC Card
Years of experience

Driving History
Previous driving experience
Accident history in past 3 years

YesNo
If Yes, please explain
Traffic Violation in past 5 Years

YesNo
If Yes, please explain
Drug and Alcohol Test Failures/Refusal

YesNo
If Yes, please Explain

Employment History
Company name*
Address*
Phone Number*
Position Held*
Hiring Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Reason for Leaving
Add more Employers

Background Check consent
I authorize Lux Express Logistics to conduct a background check, including driving records and criminal history.

Signature*
Date

Clearinghouse Consent

Please fill out all required fields

Upload Documents
Upload copy of CDL

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Upload Medical Card

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Additional upload

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Certification and Signature
Please Sign Here*

Clear
Date of Submission*

MonthDayYear
Date
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