Xpress Driver Application Form
Website Submission
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
State
Zip Code
Are you 25 years old or older?
Please Select
Yes
No
Do you have a valid CDL-A License issued from the state you live in?
Please Select
Yes
No
Do you have at least 18 months verifiable tractor/trailer experience immediately prior to employment?
Please Select
Yes
No
Have you had more than 6 jobs in the last 3 years?
Please Select
Yes
No
Have you had more than 3 moving violations in the last 3 years?
Please Select
Yes
No
If you answered yes to the above question please explain.
Have you had more than 2 out of service violations in the last 2 years?
Please Select
Yes
No
Have you ever had any of the following: DUI, Test Refusal, DWI, Drug Convictions, Reckless Driving, Hit and Run, Leaving the scene of an accident, Passing a school bus, Racing, or have you had any other felony in the past 5 years?
Please Select
Yes
No
If you answered yes to the above question please explain.
Have you passed a DOT physical?
Please Select
Yes
No
Will you take and pass a DOT drug screen?
Please Select
Yes
No
Do you give us permission to run your MVR report?
Yes, I give permission
No, do not run at this time
Submit
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