Driver Application Step Into the Driver’s Seat Join a team that values your skills and empowers your journey to success. GET STARTED! APPLICANT INFORMATIONNAME First Last EMAIL PHONEADDRESS City State / Province / Region ZIP / Postal Code DATE OF BIRTH MM slash DD slash YYYY POSITION APPLIED FOR Do you have legal right to work in the United States? Yes No Social Security Number (SSN)* Employment History (Last 10 Years)Please enter at least two previous jobs from the past 10 yearsJob History Company Name* Job Title* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Were you unemployed during this period?* Yes No Reason for Unemployment* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY ReferencesPlease enter at least two referencesReferences Full Name Company & Title Phone NumberRelationship EMERGENCY CONTACT INFORMATIONInclude names, relationships, and phone numbers of two emergency contacts.Emergency Contact Name First Last RelationshipParentSiblingSpouseFriendOtherPhone NumberEmergency Contact Name First Last RelationshipParentSiblingSpouseFriendOtherPhone NumberLICENSE INFORMATIONSTATE LICENSE # TYPE/CLASS ENDORSEMENTS EXPIRATION DATE DRIVING EXPERIENCECLASS OF EQUIPMENT DATE FROM MM slash DD slash YYYY DATE TO MM slash DD slash YYYY APPROX # OF MILES (TOTAL) ACCIDENT RECORD FOR THE PAST 3 YEARSDATES (List most recent first) MM slash DD slash YYYY NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.) # FATALITIES # INJURIES CHEMICAL SPILLS (Y/N) TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)DATE CONVICTED MM slash DD slash YYYY VIOLATION STATE OF VIOLATION PENALTY (Forfeited bond, collateral and/or points) Have you ever been denied a license, permit, or privilege to operate a motor vehicle? If yes, explainHas any license, permit, or privilege ever been suspended or revoked? If yes, explainAvailability & Work PreferencesAvailable Start Date MM slash DD slash YYYY Preferred Work ScheduleFull-TimePart-TimeWeekendsFlexibleEDUCATIONSCHOOL NAME & LOCATION COURSE OF STUDY YEARS COMPLETED OTHER QUALIFICATIONSPlease list any other qualifications that you have and which you believe should be considered. Additional Certifications & EndorsementsHazmat Certification (HME) Yes No Upload Hazmat CertificationMax. file size: 100 MB.TWIC CardYesNoUpload TWIC CardMax. file size: 100 MB.Upload Your ResumeMax. file size: 100 MB.W-9 FormMax. file size: 100 MB.Proof of InsuranceMax. file size: 100 MB.CDL (Commercial Driver’s License)Max. file size: 100 MB.
