DRIVE FOR US

PERSONAL INFORMATION

LICENSE INFORMATION

DRIVING EXPERIENCE

· Straight Truck

· Tractor and Semi-Trailer

· Tractor and B-Train

· Other

EMPLOYMENT RECORD
Applicants that desire to drive in interstate / interstate commerce must provide the following information on all employers for the past 10 years.

· Employer 1

· Employer 2

· Employer 3

ADDITIONAL INFORMATION

TO BE READ AND SIGNED BY THE APPLICANT

I authorize you to make sure investigations and inquires to personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers and other persons from a liability in responding to inquires 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 also understand, that I am required to aside by all rules and regulations of the company.

I understand that information I provide regarding current and/or previous employer(s) maybe used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review information provided by current/previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to re=send the corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if previous employer(s) and I cannot agree on the accuracy of information.