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Driver Application for Employment

1. Contact and Personal Information:

(All * are required fields.)

*Full Name
*Street Address
*City
*State
*Zip/Postal Code
*Day Phone
*Evening Phone
*Best Time to Call
*Date of Birth
*Social Security #
E-mail Address

2. Current License Information :

(license required unless a student)
License Number

State                                     Expiration Date
   

Class:
Class A
Class B
Class C
Endorsements:
Hazmat
Double/Triple
Tanker

3. Driving History & Driving Information:

*Years of tractor trailer driving experience:


*You are currently a(n):
Owner Operator
Company Driver
Student
If an Owner Operator:
How many trucks do you own?

I Would Like to Run
Single
Team
Husband/Wife
Driver School Graduate?
Yes No

Number of Accidents
(past three years)
Moving Violations
(past three years)
Experience if not a student:
HHG
Tanker
Flatbed
Van
Reefer
Specialized
Auto Carrier
Hazmat
Double/Triple
Freight type you prefer to pull:
HHG
Tanker
Flatbed
Van
Reefer
Specialized
Auto Carrier
Hazmat
Double/Triple
Regions you prefer to run (check all that apply):
Southeast
Southwest
Midwest
Northeast
Northwest
Local

Interested in lease/purchase?
Yes or No

5. Additional Comments To Tell Recruiters:




4. Employment Information:

Current Employer:
Company Name:

Street / City / State / Zip:

Starting Date:

Phone Number:

Reason For Leaving:


*Past Employer 1:
Company Name:

Street / City / State / Zip:

Starting Date:
Ending Date:
Phone Number:

Reason For Leaving:


Past Employer 2:
Company Name:

Street / City / State / Zip:

Starting Date:
Ending Date:
Phone Number:

Reason For Leaving:


Past Employer 3:
Company Name:

Street / City / State / Zip:

Starting Date:
Ending Date:
Phone Number:

Reason For Leaving:


Past Employer 4:
Company Name:

Street / City / State / Zip:

Starting Date:
Ending Date:
Phone Number:

Reason For Leaving:


6. Criminal Record (if any):

Do you have any felony convictions on your record?
Yes or No   Date: 
Do you have any charges pending for, or have you been, convicted of driving under the influence?
Yes or No   Date: 
Has your license or privilege to operate a motor vehicle ever been denied?
Yes or No   Date: 
Do you have any license or permit suspensions on your record?
Yes or No   Date: 
Do you have any charges pending or have you ever been convicted for reckless or carless operation of a motor vehicle?
Yes or No   Date: 
Do you have any charges pending for, or have you ever been convicted of possession, sale, or use of drugs?
Yes or No   Date: 
Have you ever been refused any type of insurance or been denied bonding?
Yes or No   Date: 
Have you ever been discharged or suspended?
Yes or No   Date: 

7. Application Disclaimer:

I have read and agree with the terms, conditions and use of information I am providing and I give permission to obtain consumer reports about me from DAC.
Yes   |   No

Please Click the Submit Button Once.

Thank you very much for applying.
          
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