Driver Application
Applicant Information
Full Legal Name
*
First Name
Middle Initial
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
SSN/EIN
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Street Address
*
City
*
State
*
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
Other
ZIP Code
*
Position and Availability
Position Applying For
*
Please Select
Select One
Local Driver - Set Schedule
Local Driver - PRN
Over-the-Road Driver
Local & OTR
Owner Operator
Interested In
*
Please Select
Select One
Full-Time
Part-Time
Temporary
Seasonal
Other
Availability Date
*
-
Month
-
Day
Year
Date
Preferred Schedule
Licensing and Driver Qualifications
License Type
*
Please Select
Select One
Class A
Class B
Class C
Other
Driver License Number
*
License State
*
License Expiration Date
*
-
Month
-
Day
Year
Date
Medical Card/DOT Physical Expiration Date
-
Month
-
Day
Year
Date
Endorsements
Total Years Driving Commercial Vehicles
*
Box Truck Experience
*
Please Select
Select One
Yes
No
Other
OTR Experience
*
Please Select
Select One
Yes
No
Other
Have You Driven a 26ft Box Truck?
*
Please Select
Select One
Yes
No
Other
Describe Your Driving Experience. Type N/A if not applicable
*
Employment History
Company Name
Professional Reference Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Applicant
*
Please Select
Former Supervisor
Current Supervisor
Former Manager
Current Manager
Dispatcher
Safety Manager
Fleet Manager
Co-Worker
Owner/Employer
Customer/Client
Professional Colleague
Other
Email
*
example@example.com
Reason for Leaving
*
Company Name
*
Professional Reference Name
*
Employer Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Applicant
*
Please Select
Former Supervisor
Current Supervisor
Former Manager
Current Manager
Dispatcher
Safety Manager
Fleet Manager
Co-Worker
Owner/Employer
Customer/Client
Professional Colleague
Other
Email
*
example@example.com
Reason for Leaving
*
Safety and Compliance Questions
Any accidents in the last 3 years?
*
Please Select
Select One
Yes
No
Any DMV violations in the last 3 years?
*
Please Select
Select One
Yes
No
Has your license ever been suspended or revoked?
*
Please Select
Select One
Yes
No
If yes to any safety question, explain
Are you a convicted felon and/or have a criminal record?
*
Please Select
Select One
Yes - explain in detail below
No
If yes to any safety question, explain
Can you pass a drug screening?
*
Please Select
Select One
Yes
No
Uploads and Emergency Contact
Upload Driver License
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Medical Card
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Resume
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Certifications
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Name
*
Relationship
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorizations and Signature
Authorization to obtain and review Motor Vehicle Record for employment and driver qualification purposes
*
I agree
Authorization to verify employment history, driving history, references, and other application-related information
*
I agree
Acknowledgment that employment may be contingent upon passing required drug screening, background check, and driver qualification review
*
I acknowledge
Certification that the information provided is true and complete to the best of my knowledge
*
I certify
(Type your full legal name)
*
First Name
Middle Name
Last Name
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Application
Submit Application
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