Dispatcher

If you would like to join our company, please fill in your details in this Driver 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
Zip
Phone
Email
Date of Birth
Social Security Number

Driver/Qualification Information:
Drivers License Number
State Issued Drivers License IndianaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNew CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES AFRICACANDANDAEUROPE,MIDDLE EASTARMED FORCES AFRICA(EXCEPT CANADA)ARMED FORCES PACIFIC
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? N/ADeniedSuspendedRevokedCancelled
If yes, enter a description
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
No Violations in the past three years None
Violation Date
Describe violation
Violation state
Penalty
Commercial Vehicle NoYes

Violation 2
Violation Date
Describe violation
Violation state
Penalty
Commercial Vehicle NoYes

Violation 3
Violation Date
Describe violation
Violation state
Penalty
Commercial Vehicle NoYes

List all motor vehicle collisions in which you were involved both commercial and private vehicle for the past three years, if none select NONE
No Collisions in the past three years None
Collision Date
Describe collision
Location state
How many injured
How many fatalities
Hazmat spill NoYes

Collision 2
Collision Date
Describe collision
Location state
How many injured
How many fatalities
Hazmat spill NoYes

Collision 3
Collision Date
Describe collision
Location state
How many injured
How many fatalities
Hazmat spill NoYes

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 comerce 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 most recent employer first and work to the oldest employer as required above.

Work Experience:
Current or most recent employer:
Employer Name
Address
Phone
Supervisor Name
Hire Date Ended 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.

Previous Job Experience:
Employer Name
Address
Phone
Supervisor Name
Hire Date Ended 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.

Previous Job Experience:
Employer Name
Address
Phone
Supervisor Name
Hire Date Ended 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.

Previous Job Experience:
Employer Name
Address
Phone
Supervisor Name
Hire Date Ended 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.

Education:
Select highest level completed 9101112College 1College 2College 3College 4
Describe any special training or awards you have received

Other
Have you driven for 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 is 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