New Updated Work History Step 1 of 2 - Instructions 0% Truck Driver Recruiting Company PLEASE ANSWER ALL THE QUESTIONS ON THE APPLICATIONS - DO NOT SEND ANY MEDICAL INFORMATION WITH THIS APPLICATION. Read and follow all instructions carefully. VERY IMPORTANT! The section entitled "Employment Record" must be completed correctly. You must list all employers, schools, military service and all periods of self-employment or unemployment for the most recent 10 full years. Dates, phone numbers and addresses must be correct with no period of time unaccounted for in the last 10 years. Any offer of employment will be conditioned upon successfully completing: a DOT physical and company medical screening; drug screen; criminal background check and company road test. Driver Qualification ApplicationNote: Please answer or check all questions. If the answer to any question is "No" or "None," do not leave the item blank, indicate "No" or "None." This application will not be considered unless complete.Date* MM slash DD slash YYYY Today's DateApplicant's name* First Middle Last Employment Record For The Past 10 YearsBegin with your current or most recent job and work backwards in order, listing your employers and any periods of unemployment for at least 10 years including all full and part-time employment. All time must be accounted for, including military service, school, self-employment, and periods of unemployment.Number of previous jobs, including your current one*Please enter a number from 1 to 10.Current Or Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull? 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Second Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Third Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Fourth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Fifth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Sixth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Seventh Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Eighth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Ninth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Tenth Last EmployerFrom* MM slash DD slash YYYY To* MM slash DD slash YYYY Present Employer Present Company name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone number*Position held* What type of power unit?* Day Cab Sleeper Day Cab & Sleeper N/A What type of transmission?* Automatic 9 Speed 10 Speed Super 10 13 Speed 15 Speed 18 Speed N/A What size of trailer did you pull?* 24' 48' 53' Other Other trailer size* What type of trailer have you pulled?* Dry Van Reefer Flat Bed Step Down Low Boy Curtain Side Doubles End Dump Roll Off Tanker Belly Dump Belt Trailer Container Car Hauler Live Stock Side Dump Traveling Axel Traveling Tail Other Other trailer type* Areas in which you drove* What type of deliveries have you done?* Local Regional Over The Road LTL Shuttle N/A How many stops did you do a day?* 1 to 3 4 to 7 8 to 12 13 to 17 18 to 22 Shuttle Who did you deliver to?* Warehouse/Distribution centers Retail Outlets End Users N/A How did you log your day?* Manual Log Electronic Logging System N/A Reason for leaving* How were you paid?* Per Hour Per Mileage By Percentage of the Load Other Other how paid* Satellite communication* Yes No Were you subject to DOT regulations while working for this employer?* Yes No Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?* Yes No Δ
