Truck Driver Application

Truck Driver Application Form
Contact Information
Legal Name

First NameMiddle NameLast Name
Present Address

Address 1

Address 2

CityState

Zip CodeCountry
Present Address

Street Address

Street Address Line 2

CityState

Zip Code
Country
Home/Alt. Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Maiden Name
Marital Status
Email

Confirmation Emailexample@example.com
Source/Referred by:
How did you hear about us?
License Class
Specific Job ID #
Application Information
Recruiter Name (If Known):
Personal Information

*Please be as thorough as possible and answer all required
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearEx. 02/02/1975
Social Security #
Do you live in the U.S.?
Can you read, speak, and write English fluently?
Years at Current Residence
If '5+ Years' was NOT selected for the previous question, please list your address prior to your current address:
Can we, as well as any companies that you decide to move forward on, text you regarding future opportunities?:
Highest Level of Education
Reference #1 Name:
Reference #1 Relationship:
Reference #1 Phone Number
Reference #2 Name:
Reference #2 Relationship:
Reference #2 Phone Number
Military Service

*If NO to the below question, please skip to the next section: License & Driving Information.
Were you ever in the military?
If YES, what branch?
Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Honorable Discharge?
License & Driving Information
License Class
Drivers License State
Drivers License Number
Drivers License Expiration Date

MonthDayYear
Physical Expiration Date

MonthDayYear
Endorsements
*Hold Ctrl/Cmd to select multiple items
Other Endorsements (If Applicable):
Hazmat Expiration Date (If Applicable):

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Have you held any additional licenses in the last 3 years?
If yes to the above question, please provide the additional license information:
Do you possess a valid TWIC?
TWIC Expiration Date (If Applicable):

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Do you possess a valid Passport?
Passport Expiration Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have a Sea Link card?
Which of the following do you have experience with?
*Hold Ctrl/Cmd to select multiple items
What shift(s) do you prefer?
Owner/Operator Information
Are you an owner operator? If NO, please skip to the next section: Driver Training School.
Number of trucks owned:
Truck Year
Truck Make
Truck Model
Do you own the truck outright?
Empty Gross Weight:
Wheel Base:
5th Wheel Height:
Stack Height:
Driver Training School
Have you ever attended a driving school? If NO, please skip to the next section: Employment Information.
School Name:
School City:
School State
Graduation Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employment Information

Please list your most recent employer, self-employment, or contract work completed. If you have no recent employment, please list your most recent schooling attended in the employment section below.
Employer 1 (Most Recent Employer)
Date From

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date To

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Employer 1 Name & Address

First NameLast Name
Employer 1 Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Fax

Area CodePhone Number
Operate a CMV?
Vehicle/Truck Driven
Trailer Type Hauled
# of Days Out on the Road
# of States Driven
Trailer Length
Reason for leaving?
Please Explain:
Additional Comments
May we contact this employer?
Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class A or B CDL Jobs) within the last 3-10 years?
If YES to the above question, please add more Employer information below!
Add Further Employer History Here:
Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer? Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer? Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer?
How much commercial driving experience do you have that can be verified?
*Please answer in text box provided
Have you been unemployed at any time during the last three (3) years for a period greater than ninety (90) days?
If YES to above question, please provide dates and reason:
Employment desired
Traffic Convictions
Do you have ANY traffic convictions within the last 5 years?
Traffic Conviction 1:
Date of Conviction

MonthDayYear
2 digit month, 2 digit day, 4 digit yearex: 02-20-2002
Type of Vehicle Operating
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Conviction 2:
Date of Conviction

MonthDayYear
2 digit month, 2 digit day, 4 digit yearex: 02-02-2002
Type of Vehicle Operating
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Conviction 3:
Date of Conviction

MonthDayYear
2 digit month, 2 digit day, 4 digit yearex: 02-02-2002
Type of Vehicle Operating
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Accidents
Do you have ANY vehicle accidents within the last 5 years?
Accident 1
Date of Accident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Accident Type
Vehicle Type
DOT Recordable?
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Accident 2
Date of Accident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Accident Type
Vehicle Type
DOT Recordable?
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Accident 3
Date of Accident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Accident Type
Vehicle Type
DOT Recordable?
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Background History

Please answer the following questions as accurately as possible including date, charge, and any additional comments you'd like. Please note that any previous convictions will not result in being denied employment. Providing the best explanation possible will allow us to best help you find a job!
Do you have any felony convictions within the last ten (10) years?
If yes to the above question, please explain:
Do you have any misdemeanor convictions within the last five (5) years?
If yes to the above question, please explain:
Have you ever had a drug conviction?
If yes to the above question, please explain:
Have you ever been charged with DUI/DWI?
If yes to the above question, please explain:
Have you ever had your license suspended, denied and/or revoked, or refused liability insurance?
If yes to the above question, please explain:
Have you ever been charged with Reckless Driving or Driving to Endanger?
If yes to the above question, please explain:
Have you ever tested positive or refused a pre-employment drug screen or a random drug screen?
If yes to the above question, please explain:
Confirmation & Submission

*I confirmed that the information is true and correct to the best of my knowledge.
Signature (Type Full Name):
Today's Date

MonthDayYear
Please enter the last four digits of your Social Security Number to confirm your submission:
Position(s) applied for:
Job Title
Job Location Desired
TWIC Expiration Date (If Applicable)

MonthDayYear
Should be Empty:

Truck Driver Application Form

Contact Information

Application Information

Personal Information

Military Service

License & Driving Information

Owner/Operator Information

Driver Training School

Employment Information

Traffic Convictions

Traffic Accidents

Background History

Confirmation & Submission