EmailMe Form - TRUCKERS NEEDED CORP APPLICATION

TRUCKERS NEEDED CORP APPLICATION

Please take just a few minutes to complete this form so that we can help you find a Job.

By filling out this application, you are under no obligation.

THIS IS A FREE SERVICE! It does not cost you anything to use our professional services. We are extremely motivated to help you find a job and we will bust our butts to help you! Nobody will harder then we will to help you find the job you want.

Truck Drivers we represent a large number of Trucking companies and we can help you find a Driving Job even if you have been turned down or had difficulty finding the job you want.

As soon as your application is submitted We will contact you so that we can assist your job search. Our trucking companies need drivers Immediately and they are ready to hire you right away!

Please be honest with us, these companies will pull your DAC, your MVR and your background so it's best to be up front about your situation so that we can help you find a company that will hire you.

You are highly encouraged to request a FREE copy of your DAC report so you know what is on your Record. Go to www.hireright.com or call 800-381-0645 for a FREE COPY of your DAC report.

SCROLL TO THE BOTTOM AND Click on SAVE AND RESUME LATER if you run into any problems, we will still get the form and you won't lose any data.

1: Name *
First Last
Have you ever been known by any other name or names?

If so Please put that name here!
This item will mainly apply to someone who changed their name due to marriage or divorce.
Address *

Street Address City State / Province / Region Postal / Zip Code

PLEASE DON'T FORGET TO PUT YOUR ZIP CODE ON THIS FORM. Each item is completed ABOVE the words, so for instance where it says "city" you put the CITY above where it says City, NOT BELOW!!
ZIP CODE
For verification purposes please put your Zip Code here again. *
County *
What County do you live in? (NOT COUNTRY, we need the "COUNTY" you live in)
How long at this address? *
We need 5 years of Residence history.

If you have not lived at the address above for at least 5 years, then please list residence address's for the last five years. Include dates.
IMPORTANT!! We need the MOVE IN and MOVE OUT Dates for where you lived (Month & Year) for EACH address during the last 5 years.
3: Driver Type *
Please select your current situation.
4: Email *
5: Primary Phone *
### - ### - ####
Required!
Cell Phone
### - ### - ####
Home Phone
### - ### - ####
Birth Date *
MM / DD / YYYY
Minimum age to apply is 21 years of Age. If you are not at least 21 years old, please do not apply.
Social Security Number *
We can't conduct the required Background checks, DAC Checks and MVR reports without this information.
Can you SPEAK, WRITE & Understand ENGLISH??

(If you can't understand, speak or write English please STOP the application at this point we can't get you hired) *
YES
NO
If you can't understand the dispatcher you can't get hired.
Emergency Contact: Name, Address, Phone Number and Relationship *
Required information--Put the ADDRESS and PHONE number for these people!
Reference # 1: Name, Address, Phone Number and Relationship *
Required information--Put the ADDRESS and PHONE number for these people!
Reference # 2: Name, Address, Phone Number and Relationship *
You need to list at least two references!, so please complete Reference #1 & #2

Required information--Put the ADDRESS and PHONE number for these people!
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Do you have a Smart Phone?
YES
NO
6: BEST TIME TO CALL YOU!
7: How are you most interested in working *
If TEAMS do you have a team member?
YES
NO
TEAM member name and phone number (Only applicable if you currently do have a Team Member to drive with)
If you have a current Team Member please list their information here.
Would you be willing to drive as a TEAM MEMBER? *
YES
NO
Would you be willing to for us to find you a TEAM Member to driver with if it helps you find a job??
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8: What type of Driving Jobs interest you most?

1st Choice! *
(Most regional jobs will get you home weekly or 3 out of 4 weekends. Some are 7 to 10 days)
What type of Driving Jobs interest you most?

2nd Choice! *
Selecting LOCAL ONLY OPTION will reduce your chances of getting a job greatly.
What type of Driving Jobs interest you most?

3rd Choice! *
To which Company do you wish to apply? *
To select more then one company just hold down the CONTROL key on your keyboard and you can select 1 or 2 or as many companies as you want to choose.
Have you EVER in your Life Time been employed by any of the Companies Listed here? If so please select ALL companies that you have worked for. *
To select more then one company just hold down the CONTROL key on your keyboard and you can select 1 or 2 or as many companies as you want to choose.
If you have already applied within the last 6 months to any of the companies listed here Please SELECT THOSE COMPANIES?

(if it's been longer then 6 months since you applied just skip this question) *
To select more then one company just hold down the CONTROL key on your keyboard and you can select 1 or 2 or as many companies as you want to choose.
Are you interested in a LEASE BACK Option?
YES
NO
We have numerous companies that will offer you NO Money Down, No Credit Check and great terms for a LEASE PURCHASE Option. If you list this option we can certainly find you a program that will fit your needs and budget.
If you are an Owner Operator how many trucks do you ownl
1
2
3
4
5 or More
If you are O/O. make/model/year model (OWNER OPERATORS PLEASE ENTER YOUR TRUCK INFO HERE)
Do you need pet or rider policy?
Is this a Deal Breaker? *
YES
NO
For example will you NOT accept a job if it doesn't include this option.
Are you willing to relocate? *
YES
NO
9: Comments or Clarification
Please include if there is a specific area of the country you are interested in working in, or type of job you are looking for so we can help you find it. (i.e. TANKER, REEFER, Flatbed etc)
10: DRIVER LICENSE INFO
How many years have you had a valid driver's license of any type? *
Any type of License Class E, D etc not how long you have had a Class A license, but a drivers License period.
Drivers License Number *
State Issued *
Expiration Date *
MM / DD / YYYY
Issued Date *
MM / DD / YYYY
Medical Certificate Expiration Date *
MM / DD / YYYY
If expired put the date it expired or approx date, if current we need the exact date it expires.
Hazmat Expiration Date (If Applicable)
MM / DD / YYYY
CDL CLASS *
A
Class A Permit
B
C
D
E
Do you have a TWIC card? *
YES
NO
TWIC CARD Expiration Date
MM / DD / YYYY
Do you have a current Passport? *
YES
NO
11: SAFETY RECORD
Select "ALL ITEMS" that Apply to you! *
I have a Hazardous Materials Endorsement?
I have Double/Triple Trailer Endorsement?
I have a Tanker Trailer Endorsement
I have a Passenger Endorsement
None of the Above
Are you willing to get your Hazmat endorsement if the job requires you to do so?

Selecting NO could affect your chances for a job!! *
YES
NO
Normally the endorsement is required prior to hire or within 60 days of being hired.
If you don't have Tanker Endorsement, Are you willing to learn to drive Tankers if the company we hire you for will train you for tankers for a choice job with them?
YES
NO
BACKGROUND
Have you ever had your license suspended or revoked? *
YES
NO
If you answered YES we need the DATE IT WAS SUSPENDED!!! (Give us an approx date if you don't know the exact date)
MM / DD / YYYY
When was it reinstated? If you answered YES we need the DATE when it was reinstated: *
YES
NO
If it was a long time ago just give us your approx date for reinstatement. If within the last 3 years we have to know the exact date.
Reason for Suspension & Location (If applicable) IMPORTANT!! It is very important you tell us why your license was suspended.
If yes you will need to list location (State) of the suspension REASON for the suspension. If more then one suspension please list the additional DATE, REASON, When it was reinstated for each additional suspension.
Have you ever gotten a ticket for driving with a suspended or revoked license? *
YES
NO
If you answered YES we need the DATE
MM / DD / YYYY
CMV or POV (Ticket for Driving with a suspended or revoked license)

POV = Privately Owned Vehicle
CMV = Commercial Motor Vehicle
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
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** Have you had any ACCIDENTS OR INCIDENTS in the last 5 years ?

You must list all accidents, Preventable and NON-Preventable regardless of whose fault it was. *
YES
NO
It is Critical you list ALL Accidents whether they are Preventable or Non-Preventable, and ALL incidents as they will all show up on your DAC. This includes accidents in a CMV or a POV. Some Companies required a 5 year history, some only 3 so please advise us of any within the last 5 years.

Incidents include non police report items that occur such as a problem in a drop yard, getting stuck in the mud and having to be towed etc.
If you answered YES we need the DATE
MM / DD / YYYY
Describe the accidents or Incidents (If applicable) If more then one list all of them.
If yes you will need to list location (State & City) where the accident occurred. DON'T FORGET TO LIST ANY INCIDENTS HERE TOO!
CMV or POV (Accident)
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
Do you have a copy of the Accident Report (s) or can you get it/them?
YES
NO
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2nd Accident If Applicable-If you answered YES we need the DATE
MM / DD / YYYY
Describe the accidents or Incidents (If applicable) If more then one list all of them.
If yes you will need to list location (State & City) where the accident occurred. DON'T FORGET TO LIST ANY INCIDENTS HERE TOO!
CMV or POV (Accident)
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
3rd Accident If Applicable-If you answered YES we need the DATE
MM / DD / YYYY
Describe the accidents or Incidents (If applicable) If more then one list all of them.
If yes you will need to list location (State & City) where the accident occurred. DON'T FORGET TO LIST ANY INCIDENTS HERE TOO!
CMV or POV (Accident)
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
Do you have a copy of the Accident Report (s) or can you get it/them?
YES
NO
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Have you had ANY tickets in the last 5 years? POV or CMV! *
YES
NO
Some Companies required a 5 year history, some only 3 so please advise us of any within the last 5 years.

This includes tickets in a CMV or a POV and warning tickets. This also includes non moving violations such as overweight tickets, log book violations etc.
If you answered YES we need the DATE
MM / DD / YYYY
What did you get a ticket or tickets for? If applicable)
POV or CMV?? If yes you will need to list location (City and State) along with what the ticket says.

HOW MANY MILES OVER IF SPEEDING
IF SPEEDING TICKET How many miles Over?
5 or Less
10 or Less
15 or Less
More than 15 MPH Over (You can stop the application at this point you aren't going to get hired by anybody if it's been within the last 3 years)
CMV or POV
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
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2nd ticket if applicable If you answered YES we need the DATE
MM / DD / YYYY
What did you get a ticket or tickets for? If applicable)
POV or CMV?? If yes you will need to list location (City and State) along with what the ticket says.

HOW MANY MILES OVER IF SPEEDING
IF SPEEDING TICKET How many miles Over?
5 or Less
10 or Less
15 or Less
More than 15 MPH Over (You can stop the application at this point you aren't going to get hired by anybody if it's been within the last 3 years)
CMV or POV
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
3rd ticket if applicable If you answered YES we need the DATE
MM / DD / YYYY
What did you get a ticket or tickets for? If applicable)
POV or CMV?? If yes you will need to list location (City and State) along with what the ticket says.

HOW MANY MILES OVER IF SPEEDING
IF SPEEDING TICKET How many miles Over?
5 or Less
10 or Less
15 or Less
More than 15 MPH Over (You can stop the application at this point you aren't going to get hired by anybody if it's been within the last 3 years)
CMV or POV
CMV
POV
IMPORTANT--we need to know if it's CMV or POV
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Have you been convicted of DWI, DUI or BAC in your lifetime? *
YES
NO
POV or CMV. Many companies will be okay with 5 to 7 years, some are even 3 years but that is rare. Several have a 10 year requirement so we need a full history so we know which company will accept your situation. Some only allow 2 DUI's in a lifetime.

DUI in a CMV carry a lifetime ban for most companies.
If you answered YES we need the DATE
MM / DD / YYYY
CMV or POV (DUI)
CMV
POV
Crucial that you specify if it was a POV or CMV. Many companies won't hire you period with a CMV DUI, so we need to know so we can help you.
Have you ever failed a DOT or Pre-Employment Drug or Alcohol Test? *
YES
NO
Please be honest with us, if you end up in orientation and it turns out you failed a drug test and they find out you will be sent home at your own expense.
If you answered YES we need the DATE

"IF IT'S LESS THEN 10 YEARS SINCE YOU FAILED THE DRUG TEST STOP NOW, WE CAN'T GET YOU HIRED!!!"
MM / DD / YYYY
If you answered Yes to this question and it hasn't been at least 10 years since you failed the test, You can stop the application. We can't get you hired with a failed drug/alcohol test.
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Have you ever been convicted of a felony? *
YES
NO
You will need to list the date and describe the nature of the offense below in as much detail as possible. Just because you have a felony doesn't mean you won't be hired, there are companies that will hire you but we need details to help you get hired.
If you answered YES we need the DATE
MM / DD / YYYY
What did you get a Felony for? (IF APPLICABLE)
Please visit www.felonygone.com to see if you can expunge your felony
City and State of conviction
(IF APPLICABLE)
Disposition. Were you fined, put in jail, probation (when did probation end??)
(IF APPLICABLE)
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** Have you ever been convicted of Misdeamonor? *
YES
NO
You will need to list the date and describe the nature of the offense below in as much detail as possible. Just because you have a misdeamonor doesn't mean you won't be hired, there are companies that will hire you but we need details to help you get hired.
If you answered YES we need the DATE
MM / DD / YYYY
City and State of conviction
(IF APPLICABLE)
What did you get a Misdeamonor for? (IF APPLICABLE)
Please visit www.felonygone.com to see if you can expunge your felony
Disposition. Were you fined, put in jail, probation (when did probation end??)
(IF APPLICABLE)
ADDITIONAL COMMENTS OR CLARIFICATIONS regarding any items you answered yes to above.

Or if you had additional felonies or misdemeanors you need to add or CLARIFY what happened. *
12: DRIVING EXPERIENCE
Select "ALL ITEMS" that Apply to you! *
Straight Truck
Flatbed
Reefer Operation
HAZMAT Hauling
Car Hauling
Passenger Transport
Highway Master
Military Experience
Dry Van
Tanker
Flatbed Rigging
Grocery Goods
Household Moving
Qualcomm Operation
Pickup and Delivery
Other
If you selected Other Please Specify
Do you have Over The Road Tractor Trailer Experience? *
YES
NO
OTR Definition: Sleeps in Truck, drove multiple states
When was the LAST DATE you drove a Tractor/Trailer? *
This is very important for finding a company that will accept you if you have not driven in a while.
How Much TRACTOR/TRAILER Experience do you have? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
How Much TANKER Experience do you have? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
How Much experience to you have pulling Doubles? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
How Much FLATBED Experience do you have? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
How Much Strait Truck Experience do you have? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
How Much Dry Van Experience do you have? *
If None place NONE here (We need Years and Months, & Approximate Miles. Please be precise)
OTHER?
We need the Type and Years and Months, & Approximate Miles. Please be precise what other vehicles you drove or trailers you pulled you would like us to be aware of.
How Many Months of OTR driving experience do you have in the last 12 Months *
Please be very specific how many months you actually were driving OTR in the last 12 months
How Many Months of OTR driving experience do you have in the last 36 Months *
Please be very specific how many months you actually were driving OTR in the last 12 months
Total Truck Driving Experience *
Please Select TOTAL OTR Experience
How many states have you driven in while employed as a Class A Driver? *
MISC
13: Are you currently UN-EMPLOYED? *
YES
NO
Did you ever serve in the US Armed Forces? *
YES
NO
Army, Air Force, Marines, Coast Guard, Navy?
If "YES" Please enter Rank, Branch of Service, Years served (i.e. 1990-1994) and if you had an honorable discharge.
We need to know what years you served along with the branch of service and discharge disposition so please don't forget to list those here
Truck Driving School Info
Truck Driving School? *
YES
NO
If "YES" Please enter Name of Truck Driving School Location

PUT "NONE" in this block if you never attended Truck Driving School. *
(City & State)
PUT "NONE" in this block if you never attended Truck Driving School.
If "YES" Please enter the PHONE NUMBER for the Driving School if you know it.
Trucking School Phone Number here!
If "YES" Please enter Trailer Length you trained on at Truck School. i.e. 48 Foot, 53 foot etc.

It not applicable to you put N/A here. *
MONTH & YEAR you graduated: IMPORTANT!

PUT "NONE" in this block if you never attended Truck Driving School.
If "YES" Please enter the type of TRANSMISSION you trained on at Truck School. i.e. 10 Speed, Automatic etc..

It not applicable to you put N/A here. *
MONTH & YEAR you graduated: IMPORTANT!

PUT "NONE" in this block if you never attended Truck Driving School.
How Many hours of training Approximately did you receive at Truck School? *
RECENT GRADS WITH NO EXPERIENCE: If you attended a truck school with less than 100 hours most companies will not accept you into orientation. In many cases you will have to go to a refresher or full school training program.

If you only trained on Automatics you will have to attend a full school program.
If "YES" Please enter DATE OF GRADUATION!

PUT "NONE" in this block if you never attended Truck Driving School. *
MONTH & YEAR you graduated: IMPORTANT!

PUT "NONE" in this block if you never attended Truck Driving School.
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YOUR EDUCATION LEVEL *
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14: CURRENT OR FORMER EMPLOYER
Please Start with your most Recent Employer inlcuding NON-DRIVING Jobs.

We MUST have the full 36 months of what you were doing to submit an application. this includes Unemployment time, Medical Leave, or any job you worked for the last 3 years. If you want more money we need 10 years of DRIVING EXPERIENCE below!

If you run out of room fill out the remaining information in the "ANY OTHER ADDITIONAL PREVIOUS EMPLOYERS" block below.

IT IS CRITICAL WE HAVE THE LAST 36 MONTHS OF WHATEVER YOU WERE DOING PERIOD, IT IS A DOT REQUIREMENT FOR GETTING HIRED!!!!
COMPANY NAME *
Contact
Phone *
### - ### - ####
Required!
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Employment Dates
(START DATE) *
MM / DD / YYYY
DATE YOU STARTED EMPLOYMENT
Are you still currently employed by this company today? *
YES
NO
If you answered "YES" to this question skip the STOP DATE question.
STOP DATE--If you are Not currently employed by this company please put the Date you stopped working here.
MM / DD / YYYY
IF YOU ARE CURRENTLY STILL WORKING FOR THIS EMPLOYER LEAVE THIS DATE "BLANK"
Position Title
Pay Rate
Number of Miles Driven weekly *
(Approximate)
Equipment you "Drove" or "Pulled" for THIS EMPLOYER

Select "ALL ITEMS" that Apply to you! *
Containers
Doubles
Flatbed
Lift Gate
Reefer Trailer
Tank Trailer
Van Trailer
Bus
Cabover Tractor
Conventional Tractor
Day Cab
Straight Truck
Yard Horse
Other
Reason for Leaving

(If currently employed with this company why do you want to leave) *
Please be honest. If you were terminated or let go for any reason, it is important that you let us know.

We are trying to get you hired and we will work with you but we need to know the situation.
Did you drive in Multiple States for this company? *
YES
NO
What States did you Normally drive in for this company? *
If 8 or less states please use the State Abbreviation for those states such as AL, GA, TX, AR etc.

If you drove over 8 states please state Over 9 states, or 20 states, or all Lower 48 states ETT, or you can also list a region, SW, NE, East of the Rockies, etc.
UNEMPLOYED period BETWEEN JOBS? Please list: mo/year to mo/year.
15: ANY ADDITIONAL PREVIOUS EMPLOYER
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If you don't need to add any additional Job information to complete the 3 years minimum job history, scroll to the bottom at this time, and hit SAVE AND RESUME and we will process your application.
COMPANY NAME
Contact
Phone
### - ### - ####
Required!
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Employment Dates
(START DATE)
MM / DD / YYYY
DATE YOU STARTED EMPLOYMENT
TO--->
(STOP DATE)
MM / DD / YYYY
DATE YOU ENDED EMPLOYMENT
Position Title
Pay Rate
Number of Miles Driven weekly
(Approximate)
Equipment you "Drove" or "Pulled" for THIS EMPLOYER

Select "ALL ITEMS" that Apply to you!
Containers
Doubles
Flatbed
Lift Gate
Reefer Trailer
Tank Trailer
Van Trailer
Bus
Cabover Tractor
Conventional Tractor
Day Cab
Straight Truck
Yard Horse
Other
Reason for Leaving
Please be honest. If you were terminated it is important that you let us know. We are trying to get you hired and we will work with you but we need to know the situation.
Did you drive in Multiple States for this company?
YES
NO
What States did you Normally drive in for this company?
If 8 or less states please use the State Abbreviation for those states such as AL, GA, TX, AR etc.

If you drove over 8 states please state Over 9 states, or 20 states, or all Lower 48 states ETT, or you can also list a region, SW, NE, East of the Rockies, etc.
UNEMPLOYED period BETWEEN JOBS? Please list: mo/year to mo/year.
16: ANY ADDITIONAL PREVIOUS EMPLOYER
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COMPANY NAME
Contact
Phone
### - ### - ####
Required!
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Employment Dates
(START DATE)
MM / DD / YYYY
DATE YOU STARTED EMPLOYMENT
TO--->
(STOP DATE)
MM / DD / YYYY
DATE YOU ENDED EMPLOYMENT
Position Title
Pay Rate
Number of Miles Driven weekly
(Approximate)
Equipment you "Drove" or "Pulled" for THIS EMPLOYER

Select "ALL ITEMS" that Apply to you!
Containers
Doubles
Flatbed
Lift Gate
Reefer Trailer
Tank Trailer
Van Trailer
Bus
Cabover Tractor
Conventional Tractor
Day Cab
Straight Truck
Yard Horse
Other
Reason for Leaving
Please be honest. If you were terminated it is important that you let us know. We are trying to get you hired and we will work with you but we need to know the situation.
Did you drive in Multiple States for this company?
YES
NO
What States did you Normally drive in for this company?
If 8 or less states please use the State Abbreviation for those states such as AL, GA, TX, AR etc.

If you drove over 8 states please state Over 9 states, or 20 states, or all Lower 48 states ETT, or you can also list a region, SW, NE, East of the Rockies, etc.
UNEMPLOYED period BETWEEN JOBS? Please list: mo/year to mo/year.
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ANY OTHER ADDITIONAL PREVIOUS EMPLOYERS

(The More Verifiable Employment time you give us the more money you can make as many companies pay based on YEARS OF EXPERIENCE)
If you have additional TRUCK DRIVING Employers you would like to submit to complete at least 10 years of Employment, PLEASE LIST THEM HERE in this block in the following Format:

COMPANY NAME: ADDRESS: PHONE: START DATE: END DATE: JOB DESCRIPTION (I.E. OTR Driver, Local Driver, etc)
Any Additional UN-EMPLOYMENT TIMES
Please fill in ANY/ALL UNEMPLOYMENT dates NOT listed above within a ten year period as Federal law dictates that we MUST have a full 10 year coverage for candidates of employment. Ex: 02/2011 to 07/2011
16: ADDITIONAL COMMENTS
STOP HERE AND READ THIS ITEM:

Additional Comments:

YOU MUST PROVIDE US WITH AT LEAST 3 YEARS OF EMPLOYMENT/UNEMPLOYMENT OR WHATEVER YOU WERE DOING FOR THE LAST 3 YEARS.

We can not submit your application unless we know what you were doing all the way back to FEB 2011. If you don't have work or unemployment experience listed above all the way back to FEB 2011 THEN YOU NEED TO FILL IT IN HERE IN THIS BLOCK

WE NEED TO KNOW THE COMPANY NAME, CITY, YOUR POSITION AND THE DATES YOU STARTED AND STOPPED WORKING FOR THEM!!

If you have listed jobs through 2010 above then you can skip this block unless you have other information you want to tell us.
Is there any other information you would like us to know? The more information you provide us with the better chance we have of finding you a job.
17: RESUME (Optional)
You can attach your RESUME or any other file you would like us to review here. Just hit "Browse" and upload the file from your computer.
How did you find us? *
Please try to be as accurate as you can on how you found this website application form.
*
I certify that I personally completed this application for the purpose of employment and that all the information herein is true and correct. I authorize any employer receiving this information to do a complete background investigation in accordance with federal and state laws. In accordance with FMCSR Section(s) 382.405, 382.413, and 391.23, I authorize release of any information, including all information related to my alcohol and controlled substances testing and training records by my former employers and hold them harmless of any liability from release of said information.
Date Time *
MM / DD / YYYY
SIGNATURE
Clear
Please Sign your full legal Signature in this Block using your mouse
PLEASE CLICK ON THE SUBMIT BUTTON BELOW TO COMPLETE THIS APPLICATION!

IF YOU EXPERIENCE ANY PROBLEMS when
you hit SUBMIT and this form won't submit, , Click on "SAVE AND RESUME LATER" words in blue below.

(DON'T WORRY AS LONG AS YOU SAVE THIS FORM WE WILL STILL RECEIVE IT AND YOU WON'T LOSE ANY DATA)
I didn't experience any problems
When I hit SUBMIT it wouldn't work so I am going to click on SAVE AND RESUME LATER
We will still get the form and you won't lose any of your information. Again Please click on SAVE AND RESUME LATER if you have problems submitting this form.

No Preference Find the Best one for me
Bruenger Trucking
SWIFT
Celadon
COMCAR
CRST Malone
CRST Van Expedited
CR England
EPES Transport
EW Wylie
Heartland Express
Jacobson
Metropolitan Trucking
National Carriers
NFI (National Freight)
Roadrunner Transportation (MSI, D&E, Sargent)
Sharkey Transportation
Schillie Corp/MDS, CCI, BTC, TTI
Schneider National
Steven Sanders/Wiley Sanders Trucklines
Transport America
Town Air Frieght
US Xpress
VENTURE

I have never worked for any of the companies listed below
Arnold Transportation
Averitt Express
Bruenger Trucking
SWIFT
Celadon
Combined Transport
COMCAR
CRST Malone
CRST Van Expedited
CR England
EPES Transport
EW Wylie
Heartland Express
JB Hunt
Jacobson
Landair Express
Metropolitan Trucking
National Carriers
New Century
NFI (National Freight)
Oakley Transport
Roadrunner Transportation (MSI, D&E, Sargent)
RWI
ROEHL
RBX
SAV Transportation
Sharkey Transportation
Sunco Carriers
Schillie Corp/MDS, CCI, BTC, TTI
Schneider National
Smokey Point Dist
Steven Sanders/Wiley Sanders Trucklines
Tango
Transport America
Town Air Frieght
Texas Star Express (TSE)
Trade Winds
US Xpress
Woodly Bogler
Venture

I haven't applied Online or with another recruiter to any of the companies listed below
Arnold Transportation
Averitt Express
Bruenger Trucking
Bay & Bay/DT
Celadon
Combined Transport
COMCAR
CRST Malone
CRST Van Expedited
CR England
EPES Transport
EW Wylie
Heartland Express
JB Hunt
Jacobson
Landair Express
Metropolitan Trucking
National Carriers
New Century
NFI (National Freight)
Oakley Transport
Roadrunner Transportation (MSI, D&E, Sargent)
RWI
RBX
SAV Transportation
Sharkey Transportation
Sunco Carriers
Schillie Corp/MDS, CCI, BTC, TTI
Schneider National
Smokey Point Dist
Steven Sanders/Wiley Sanders Trucklines
Tango
Transport America
Town Air Frieght
Texas Star Express (TSE)
US Xpress
Woodly Bogler

O Months
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
13 Months
14 Months
15 Months
16 Months
17 Months
18 Months
19 Months
20 Months
21 Months
22 Months
23 Months
24 Months
25 Months
26 Months
27 Months
28 Months
29 Months
30 Months
31 Months
32 Months
33 Months
34 Months
35 Months
36 Months

O Months
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
13 Months
14 Months
15 Months
16 Months
17 Months
18 Months
19 Months
20 Months
21 Months
22 Months
23 Months
24 Months
3+ Years
4+ Years
5+ Years
6+ Years
7+ Years
8+ Years
9+ Years
10+ Years
15+ Years
20+ Years
25+ Years

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10: DRIVER LICENSE INFO

11: SAFETY RECORD

BACKGROUND

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12: DRIVING EXPERIENCE

MISC

Truck Driving School Info

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14: CURRENT OR FORMER EMPLOYER

15: ANY ADDITIONAL PREVIOUS EMPLOYER ---------------------------------------------------------------------------------

16: ANY ADDITIONAL PREVIOUS EMPLOYER ---------------------------------------------------------------------------------

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16: ADDITIONAL COMMENTS

15: ANY ADDITIONAL PREVIOUS EMPLOYER
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16: ANY ADDITIONAL PREVIOUS EMPLOYER
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