How To Apply

Drivers and Independent Contractors

Application for Employment
Incomplete applications will not be processed. Required fields are displayed in red.

NAME AND ADDRESS
Last Name: First Name: Middle Name:		Email Address : SSN :
Street Address:		City :
State :	Zip Code:
Cell Phone Number:		Phone Number:

Applying as a:
Company Driver Independent Contractor  

Have you worked here before?
YES NO

How did you hear about this company?
Advertisement From a Friend From a Relative Other

Are you eligible to Work in the US?
YES NO

Interested in:
Van Flatbed

If interested in Flatbed, what region?

East
West
Midwest
Heavy	(Fort Dodge and McPherson Only)
48 States

DRIVERS LICENSE INFORMATION:

License #:

State:

Expiration:

Are you over 23 Years of Age?
YES NO

ENDORSEMENTS:

Current License CDL Class:
YES NO

Combination vehicles over 26,001 lbs.:
YES NO

Hazardous Materials:
YES NO

Air Brakes:
YES NO

EXPERIENCE LEVEL:

Years:


Type:
VAN FLATBEDApprox. # of Miles

Have you EVER been denied a license, permit or privilege to operate a motor vehicle?
YES NO

Have you EVER had any license permit or privilege suspended or revoked?
YES NO

Have you EVER been convicted for driving while under the influence of alcohol or drugs?
YES NO

Have you EVER been refused liability insurance?
YES NO

Have you EVER been convicted of a felony?
YES NO

Have you EVER been disqualified to drive by Federal Regulations?
YES NO

Have you EVER been refused a security bond?
YES NO

Have you ever tested positive, or refused to take a pre-employment alcohol/drug screening, whether the employer hired you or not, within the past three (3) years?
YES NO

If answer to ANY question is yes, state details, circumstances, and date:

ACCIDENT INFORMATION:

Any accidents in the past 3 years?
YES NO

Date	Injuries: YES NO
Nature of Accident	Preventable: YES NO

Date	Injuries: YES NO
Nature of Accident	Preventable: YES NO

Date	Injuries: YES NO
Nature of Accident	Preventable: YES NO

Date	Injuries: YES NO
Nature of Accident	Preventable: YES NO

NUMBER OF TRAFFIC VIOLATIONS IN THE PAST 3 YEARS:

TRAINING:

Have you recently, or are you currently attending a truck driving school?
YES NO

School Name:	School Address: (City/State/Zip)
School Phone:	Dates Attended:
Length of Course: Weeks Hours	Did you receive a certificate? YES NO
What was your GPA?

EMPLOYMENT HISTORY FOR 5 YEARS

EMPLOYMENT HISTORY FOR 5 YEARS
Previous Employer:

Company Name:
Address:
City:
State:	Zip Code:
Position Held:
Dates of Employment:	From:  To:
Phone Number:
Supervisor:
Type of Equipment Operated:
# of States:

Reason for Leaving:


Were you subject to FMCSR regulations?
YES NO

Was this a DOT Safety Sensitive Position as described by 49 CFR Part 40?
YES NO

May we contact this Employer?

EMPLOYMENT HISTORY FOR 5 YEARS
Previous Employer:

Company Name:
Address:
City:
State:	Zip Code:
Position Held:
Dates of Employment:	From:  To:
Phone Number:
Supervisor:
Type of Equipment Operated:
# of States:

Reason for Leaving:


Were you subject to FMCSR regulations?
YES NO

Was this a DOT Safety Sensitive Position as described by 49 CFR Part 40?
YES NO

May we contact this Employer?

EMPLOYMENT HISTORY FOR 5 YEARS
Previous Employer:

Company Name:
Address:
City:
State:	Zip Code:
Position Held:
Dates of Employment:	From:  To:
Phone Number:
Supervisor:
Type of Equipment Operated:
# of States:

Reason for Leaving:


Were you subject to FMCSR regulations?
YES NO

Was this a DOT Safety Sensitive Position as described by 49 CFR Part 40?
YES NO

May we contact this Employer?

EMPLOYMENT HISTORY FOR 5 YEARS
Previous Employer:

Company Name:
Address:
City:
State:	Zip Code:
Position Held:
Dates of Employment:	From:  To:
Phone Number:
Supervisor:
Type of Equipment Operated:
# of States:

Reason for Leaving:


Were you subject to FMCSR regulations?
YES NO

Was this a DOT Safety Sensitive Position as described by 49 CFR Part 40?
YES NO

May we contact this Employer?

MILITARY STATUS:

ADDITIONAL COMMENTS: