Independent Contractor, Future trucking pro and Company Job Application
Full Name
*
First Name
Middle Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Phone Number
-
Area Code
Phone Number
Email Address
*
example@example.com
Do you have your own operating authority ?
1 Yes
2 No
Class A License number
Class C License Number
*
How long have you been driving a CMV ?
What kind of truck do you operate ?
Is your truck registered ?
Applying for Position
*
Freight Agent
Driver
Recruiting
Sales
Dispatcher
Safety
Owner Operator
New Driver
Other
When can you start
-
Month
-
Day
Year
Date
Company Applying For
Upload Resume
Upload a File
Cancel
of
Have you ever worked for this company before
*
Yes
No
PHYSICAL EXAM EXPIRATION DATE
Employment History
Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self employment periods, and all commercial driving experience for the past ten (10) years. Write in the additional space section to complete the 10 years.
Last or current job ..
Were you subject to the FMCSRs while employed here?
Yes
No
Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to the drug and alcoholtesting requirements of 49 CFR Part 40?
Yes
No
2nd Job
Were you subject to the FMCSRs while employed here ?
Yes
No
Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to the drug and alcoholtesting requirements of 49 CFR Part 40?
Yes
No
3rd Job
Were you subject to the FMCSRs while employed here?
Yes
No
Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to the drug and alcoholtesting requirements of 49 CFR Part 40?
Yes
No
Additional Job Space.
Have you ever been convicted of a felony in the last 5 years. If so explain below.
Yes
No
Explain any convictions here.
Have you ever been convicted of a DWI ?
Yes
No
Driver’s License (list each driver’s license held in the past three(3) years:
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
List states operated in, for the last five (5) years:
List special courses/training completed (PTD/DDC, HAZMAT, ETC)
Accident Record for past three (3) years:
List any Safe Driving Awards you hold and from whom:
Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations):
Do you have any freight brokering experience ?
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described inthe job description)?
Yes
No
Do you have an updated version of the Business Book ?
Do you have a computer with Internet service, a copier and scanner ?
List three (3) persons for references, other than family members, who have knowledge of your safety habits.
Name, Address, Phone Number
Name, Address, Phone Number
Name, Address, Phone Number
To Be Read and Signed by Applicant: It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Date
-
Month
-
Day
Year
Date Picker Icon
Signature
Submit
Should be Empty: