Truckers For USA On-Line Driver Application

Accident Date:

Vehicle
Check One

Property Damage

Bodily Injury

Accident Type
(backing,turning,etc.)

Commercial

/Personal

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non job related medical condition or handicap.

Applications completed in full receive the best placements.
Positions are limited until 2007
Please check back then

Email Address

Full Name

Social Security Number ("Drivers Outside USA"WILL GET ON ARRIVAL)

Referred By:

Address

City

State : Home Zip Code (post code)

Phone Number

Date of Birth (month/date/year) Age

Years of Verifiable OTR Experience

Years OTR Exper. (Last 3 Years)

What position are you applying for?

Company Driver

Lease Driver

Owner/Operator

CDL Number (license number) State :

HEAVY Vehicle Licence# State : Class
licence :

Accidents (Last 3 Years)

Moving violations in last 3 Yrs:

Has your License ever been suspended? Yes No If Yes When:

How long have you had your class A CDL? (heavy class license)

Any DUI/DWI Charges?

Any Reckless Driving Charges? Yes No If Yes When:

HazMat Endorsement? Yes No

List any felony convictions with dates:

Can you go into Canada? Yes No If No Why not?:

Have you ever been convicted of any crime, misdeamor, or felony? Yes No

If Yes to the above, please explain:

Have you ever been involved drug/alcohol related matter that was investigated by law? Yes No

If Yes to the above, List details:

Accident History

Traffic Convictions

Date	State	Charge	Penalty

EMPLOYMENT HISTORY

List Jobs All driver applicants to the United States must provide the employment history on all employers for the previous 3 years of heavy vehicle driving . PLUS you must also provide an additional 7 years information on employment history.(10 years all up) This is a Department of Transport requirement for interstate commercial driver applicants who intend to drive a commercial motor vehicle.
Please list starting with the most recent.

Company Name

Type of Employment: Driver Other
If other, describe job type:

Address Line 1

Address Line 2

City State: Zip Code

Contact, Title, Phone Number:

Reason for leaving:

Date Hired: Date Terminated:

Pay Rate:

#Miles Driven: State: or Region ran:

Material Hauled: FREIGHT:

Vehicle driven: Trailer Type:

Company Name

Type of Employment: Driver Other
If other, describe job type:

Address Line 1

Address Line 2

City State: Zip Code

Contact, Title, Phone Number:

Reason for leaving:

Date Hired: Date Terminated:

Pay Rate:

#Miles Driven: State: or Region ran:

Material Hauled: FREIGHT:

Vehicle driven: Trailer Type:

Company Name

Type of Employment: Driver Other
If other, describe job type:

Address Line 1

Address Line 2

City State: Zip Code

Contact, Title, Phone Number:

Reason for leaving:

Date Hired: Date Terminated:

Pay Rate:

#Miles Driven: State: or Region ran:

Material Hauled: FREIGHT:

Vehicle driven: Trailer Type:

Company Name

Type of Employment: Driver Other
If other, describe job type:

Address Line 1

Address Line 2

City State: Zip Code

Contact, Title, Phone Number:

Reason for leaving:

Date Hired: Date Terminated:

Pay Rate:

#Miles Driven: State: or Region ran:

Material Hauled: FREIGHT:

Vehicle driven: Trailer Type:

Company Name

Type of Employment: Driver Other
If other, describe job type:

Address Line 1

Address Line 2

City State: Zip Code

Contact, Title, Phone Number:

Reason for leaving:

Date Hired: Date Terminated:

Pay Rate:

#Miles Driven: State: or Region ran:

Material Hauled: FREIGHT:

Vehicle driven: Trailer Type:

List any trucking, transportation or other experience that may help in your work for this company.

List any courses and training you have completed.

Comments

Passport Information

Do you have a current passport?: YES / No

Full Name

Date of Birth in full (month/date/year)

Country of Birth

USA Social Security number (if any)

Country where passport was or will be issued

Expiration Date of Passport (month/date/year)

Last 6 digits of your passport

Disclosure and Release

In order to complete your application we may obtain a consumer report from HIRECHECK services. We cannot process your application without it. If you are not hired based on the information from this report we will notify you. You have the right with in 60 (sixty) days after you received this notice to obtain a free copy of this report from HIRECHECK services and dispute its Accuracy.

I need your permission to obtain this report.

Yes In connection with my application for employment (including contract for services), I understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me including consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience along with reasons for termination of past employment. Further I understand that you will be requesting information from various Federal, State, local and other agencies which contain my past activities.

I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information.

I have the right to make a request of CIC Applicant Background Checks, upon proper identification and the payment of any authorized fees, for the information in its files on me at the time of my request.

I further authorize ongoing procurement of the above mentioned reports at any time during my employment (or contract).

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