If you would like to join our company, please fill in your details on the Application Form below and you will be automatically be added to our system and reviewed. In compliance with all Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status or non-job related disability. I understand that information I provide regarding current and/or previous employers may be used and those employers will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I also understand that I have the right to: Review information provided by previous employers. Have errors in the information corrected by previous employers and for the previous employers to resend the corrected information to the prospective employer Have a rebuttal statement attached to the alleged erroneous information if the employer and I cannot agree on the accuracy of the information. Applicant Information: First Name Last Name Street Address City StateIndianaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNew CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES Zip Phone Email Date of Birth Social Security Number Driver/Qualification Information: Drivers License Number State Issued Drivers LicenseIndianaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNew CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES Do you have a valid CDL?NoYes CDL type?Class AClass BClass COperator Do you have Hazmat and Tanker Endorsements?NoHazmatTankerHazmat & Tanker Has your permit or license to operate a motor vehicle ever been denied, suspended, revoked or cancelled?NoDeniedSuspendedRevokedCancelled If yes, enter a description, if no type none Do you have a TWIC card?NoYes Do you have experience hauling oil/petroleum?NoYes Traffic Violations: List all motor traffic violations which you were involved both commercial and private vehicle for the past three years other than parking, if none select NONE If there are no Violations in the past three years select None and skip to collisions section.None Violation Date Describe violation Violation state Penalty Commercial VehicleNoYes List all motor vehicle collisions in which you were involved both commercial and private vehicle for the past three years, if none select NONE If there are no Collisions in the past three years select None and skip to Work Experience sectionNone Collision Date Describe collision Location state How many injured How many fatalities Hazmat spillNoYes In accordance with CFR 391.21&.23 of the Federal Motor Carrier Safety Regulations (FMCSR) an applicant must list all previous work experience for the three (3) years prior to the date of this application as well as the driving experience for seven (7) years prior to those three years for a total of ten (10) years. The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: 1) weighs more than or has a GVWR of 10,001 pounds or more, 2) is designed to transport 9 or more passengers or 3) is of any size and is used to transport hazardous materials in a quantity requiring placarding. All employment gaps must be explained. If you were an owner operator, list carriers you were leased to. Please enter your most recent employer. Work Experience: Current or most recent employer: Employer Name Address Phone Supervisor Name Hire DateEnd date Job Description Reason for leaving Were you subject to controlled substance and alcohol testing specified by 49 CFR Part 40 during this period?NoYes Was this job subject to FMCSA Regulations?NoYes Describe any periods between this job and prior job, include dates, if no gaps type none. Education: Select highest level completed 9101112Some CollegeCollege Degree Describe any special training or awards you have received Other Have you been employed by us before?NoYes Are there any reasons you may not be able to perform the job which you are applying for??NoYes Have you ever been convicted of DUI, DWI or OWI?N/ADUIDWIOUI Available Start Date By typing my name in this form and submitting to potential employer, I authorize the carrier to make such inquiries of my personal, employment, driving, financial and/or medical history and other related matters as may be necessary in arriving at an employment decision. Inquiries into medical history will be made only if and after a conditional offer of employment has been extended. I hereby release all employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I agree to abide by the rules and regulations of the carrier as well as the Federal Motor Carrier Safety Regulations. I also agree and understand that if I am selected to drive for the carrier that I will be on a probationary period during which time I may be discharged 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. Typed Full Applicant Name Todays Date Enter the captcha code shown below A SMALL RESPONSE WINDOW WILL SHOW UP AT THE BOTTOM OF THIS APPLICATION ONCE IT HAS BEEN COMPLETED AND YOU HIT SUBMIT, IT WILL THEN VANISH, THAT IS ALL THAT YOU WILL RECEIVE TO KNOW YOUR SUBMISSION WAS SENT.