Reeser Trucking

DRIVER APPLICATION

Please give complete answers to ALL questions - Incomplete answers will only slow, or stall the application and our goal is to get you hired quickly.

Thank you Drivers - No matter WHO you drive for!

Position/Lane Applying For

Full Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Were you at this address 3 years or more

Yes No

Please list prior 3 year addresses here and please be complete

Social Security Number *

Date of Birth *

Month Day Year

Phone Number *

Area Code Phone Number

E-mail *

Have you ever been known by any other name?

Yes No

Please list name

Explain ie; maiden name, name change

If hired, can you furnish proof you are eligible to work in the U.S.? *

Yes No

Are you at least 23 years of age or older? *

Yes No

Have you held a VALID US license for the past 36 months? *

Yes No

License Class *

License Number *

State of Issue *

License expiration date *

Month Day Year

Expiration date of DOT physical card

Month Day Year

CDL Endorsements *

None Tanker Doubles/Triples Hazmat X Endorsement TWIC

Hazmat expiration date

Month Day Year

TWIC expiration date

Month Day Year

Please list any licenses held in other states for the previous 5 years, include license numbers if you can.

Were you ever in the military? *

Yes No

Branch of service

Please list Dates of enlisment

Enlist date - Discharge date

Did you receive an honorable discharge?

Yes No Other

Do you have, or can you obtain your DD214?

Yes No I can obtain one

Have you been to truck driving school?

Yes No

School information

School Name

Dates of attendance

City State / Province

GPA if available Country

School phone number

Area Code Phone Number

Did you graduate?

Yes No

Work History: Please list current, or most recent employment first

Start date *

Month Day Year

Ending date *

Month Day Year

Employer Name *

City, State *

Employer phone *

Area Code Phone Number

Position Held *

Reason for leaving *

Is this your current employer? *

Yes No

May we contact this employer at this time? *

Yes No

Was this a driving position?

Yes No

Type of truck

Type of trailer

Trailer length

Number of states driven

NEXT EMPLOYER

Start date

Month Day Year

Ending date

Month Day Year

Employer Name

City, State

Position Held

Reason for leaving

Employer phone

Area Code Phone Number

Was this a driving position?

Yes No

Type of truck

Type of trailer

Trailer length

Number of states driven

NEXT EMPLOYER

Starting date

Month Day Year

Ending date

Month Day Year

Employer Name

City, State

Position Held

Employer phone

Area Code Phone Number

Reason for leaving

Was this a driving position

Yes No

Type of truck driven

Type of trailer

Trailer length

Number of states driven

Start Date

Month Day Year

End Date

Month Day Year

Employer Name

City and State

Position

Employer Phone

Area Code Phone Number

Reason for leaving

Was this a driving position

Yes No

Type of truck driven

Type of trailer

Trailer length

Number of states driven

If you need additional space for past employment, please enter it here and include ALL information previously asked for.

Have you had any moving violations in the last 5 years? *

Yes No

If yes, please list City, County and State, month, year and nature of offense and any fines involved

Please list miles over limit for speeding

Has your license suspended ever been suspended? *

Yes No

If yes, please give date and length of supension. List reason why, city, county and state

List all details asked for

Have you had any accidents in the last 5 years? *

Yes No

If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)

Have you ever had a DUI, DWI, or OVI? *

Yes No

If yes, please list date of offense, jail time, fine and or suspension time.

We must have complete information to satisfy isusance carrier requirements.

Have you ever been convicted of a felony? *

Yes No

If yes, please give date and nature of offense, city, county, state and any fines and time served

Please list EVERYTHING asked for per isurance requirements

Have you ever been convicted of a misdemeanor? *

Yes No

If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines

Please list EVERYTHING asked for

Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Number of years known

Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Number of years known

Full Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Relationship to you *

Phone Number *

Area Code Phone Number

HIGH SCHOOL

Name & City/State of High School

Did you graduate?

Yes No

Official Disclosure Statement:

I certify that I personally completed this application and that all of the information is true and correct to the best of my knowledge.

Authorization to Release Records

I authorize the carrier subscribers indicated on this application to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by these carrier subscribers and hold them harmless of all liability from the release of said information.

I hereby request and authorize to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application.

Choose ONE: *

I ACCEPT I DO NOT accept

By signing I agree I have read the above statements

General Information

License Information

EMPLOYMENT HISTORY

Additional Information

Additional Information

References: Please list name, address, phone and years known.

Emergency contact information