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22
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1
Name
First Name
Last Name
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2
Phone Number
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Area Code
Phone Number
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3
Email
example@example.com
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4
CDL Class
CDL DETAILS
Please Select
Class A
Class B
Class C
Please Select
Please Select
Class A
Class B
Class C
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5
Do you have a valid CDL?
Do you have a valid CDL?
YES
NO
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6
Years of Experience
*
This field is required.
CDL DETAILS
No Experience
Less than 6 months
Less than 1 year
Less then 3 years
More than 5 years
More than 10 years
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7
State of Issue
CDL DETAILS
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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8
Any violations in the last 3 years?
Please Select
No violations
1 violation
2 violations
3 violations
Please Select
Please Select
No violations
1 violation
2 violations
3 violations
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9
Any Accidents in the last 3 years?
Please Select
No accidents
1 accident
2 accidents
Please Select
Please Select
No accidents
1 accident
2 accidents
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10
Endorsements?
CDL DETAILS
Hazmat
Tanker
Doubles
None
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11
Route Types - First Option
Please Select
OTR
LOCAL
REGIONAL
Please Select
Please Select
OTR
LOCAL
REGIONAL
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12
Route Types - Second Option
Please Select
OTR
LOCAL
REGIONAL
Please Select
Please Select
OTR
LOCAL
REGIONAL
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13
Route Types - Third Option
Please Select
OTR
LOCAL
REGIONAL
Please Select
Please Select
OTR
LOCAL
REGIONAL
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14
When can you start?
Please Select
Immediate
Within 2 weeks
Within a month
More than a month
Please Select
Please Select
Immediate
Within 2 weeks
Within a month
More than a month
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15
Total_Score
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16
Upload front of CDL
*
This field is required.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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17
Upload back of CDL
*
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Max. file size
: 10.6MB
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18
Upload valid med card
*
This field is required.
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Max. file size
: 10.6MB
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19
Birthdate
-
Date
Year
Month
Day
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20
BACKGROUND CHECK CONSENT
I authorize LMDR to: - Verify my MVR - Conduct background check - Contact previous employers
YES
NO
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21
SSN will be required for the verification phase
If matched with carrier, we will seek verification of your previous work history.
YES
NO
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22
FINAL CONSENT
I confirm that: - All information is accurate - I agree to Privacy Policy - I agree to Terms of Service - I consent to job-related communications
YES
NO
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23
Please verify that you are human
*
This field is required.
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