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Please fill out the form below and click the submit button.

MUST BE A U.S. RESIDENT
All Fields with an asterick (*) are required.
>> Contact and Personal Information:
* Full Name


* Street Address


* City
 * State
 * Zip/Postal Code

* Day Phone
* Evening Phone
* Best Time to Call

* Date of Birth
* Social Security #
E-mail Address


>> Current Driver's License Information (license info required):
License Number


State                                      Expiration Date
   

Class:
 
 Class A
Class A Required.
 Endorsements:
 
 Hazmat
Double/Triple
Tanker

>> Driving History & Driving Information:
* Years of tractor trailer driving experience:


* You are currently a(n):
Owner Operator
Company Driver
If an Owner Operator:
How many trucks do you own?

Driver School Graduate?
Yes No

I Would Like to Run
Single
Team
Husband/Wife
Number of Accidents
(past three years)
 
 Traffic Convictions/Violations
(past three years, other than parking violations):
 

Experience:
HHG Tanker Flatbed
Van Reefer Specialized
Auto Carrier Hazmat Double/Triple

Regions you prefer to run (check all that apply):
Southeast Southwest Midwest
Northeast Northwest Local

Interested in leasing/buying a Tractor with a Carrier Plan?
Yes
No

>> Employment Information:

Please Provide 10 Years of Information.
Use the Comments Section (bottom of app) if you have more than 5 employer's worth of information.
CURRENT EMPLOYER:

Company Name:

Street / City / State / Zip:
Starting Date:
 Phone Number:
Position At This Company:

Were you subject to FMCSR's while employed here? Yes | No

Was the job designated as a safety sensitive function in any D.O.T regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes | No

PAST EMPLOYER 1:

Company Name:

Street / City / State / Zip:
Starting Date:
 Ending Date:
 Phone Number:
Position At This Company:

Were you subject to FMCSR's while employed here? Yes | No

Was the job designated as a safety sensitive function in any D.O.T regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes | No

PAST EMPLOYER 2:

Company Name:

Street / City / State / Zip:
Starting Date:
 Ending Date:
 Phone Number:
Position At This Company:

Were you subject to FMCSR's while employed here? Yes | No

Was the job designated as a safety sensitive function in any D.O.T regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes | No

PAST EMPLOYER 3:

Company Name:

Street / City / State / Zip:
Starting Date:
 Ending Date:
 Phone Number:
Position At This Company:

Were you subject to FMCSR's while employed here? Yes | No

Was the job designated as a safety sensitive function in any D.O.T regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes | No

PAST EMPLOYER 4:

Company Name:

Street / City / State / Zip:
Starting Date:
 Ending Date:
 Phone Number:
Position At This Company:

Were you subject to FMCSR's while employed here? Yes | No

Was the job designated as a safety sensitive function in any D.O.T regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40?
Yes | No

Please Provide 10 Years of Information.
Use the Comments Section (bottom of app) if you have more than 5 employer's worth of information.

>> Criminal Record (if any):
Have you ever been convicted of a felony? Yes | No   Date:
Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes | No   Date:
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes | No   Date:
Has any license, permit or privilege ever been suspended or revoked? Yes | No   Date:
Have you ever been convicted, or are any charges pending, for reckless or careless operation of a motor vehicle? Yes | No   Date:
Have you ever been convicted, or are any charges pending, for possession, sale or use of a narcotic drug, amphetamines, or derivatives thereof? Yes | No   Date:
Have you ever been refused any type of insurance or been denied bonding? Yes | No   Date:
Have you ever been discharged or suspended? Yes | No   Date:
Additional Comments Section:

>> Application Disclaimer:
By submitting this application I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Carrier Companies and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from DAC Services. DAC is a consumer reporting agency. Any decision they make not to hire you based on information contained in your consumer report will be their decision alone. DAC does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies them selves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report.Your consent for these companies to obtain the report from DAC is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.

I have read the above release and I give permission to obtain consumer reports about me from DAC.
Yes   |   No



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Copyright © 2005 Tankstar USA, Inc

Copyright © 2005 Tankstar USA, Inc