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Personal Information
Full Name
Current Address
Current street name
Apartment#
City
State
ZIP Code
Residence 3 years or longer (If No, previous addresses shown below)
Yes
No
Date of Birth
Primary Phone
Your email
General Information
What position are you applying for ?
—Please choose an option—
Company Solo/Team drivers
Owner operators
Are you legally eligible for employment in the United States ?
Yes
No
Are you currently employed?
Yes
No
Do you read, write, and speak English?
Yes
No
Have you ever worked for this company before?
Yes
No
Do you have a current TWIC card?
Yes
No
Have you ever been known by any other name?
Yes
No
How did you hear about us?
—Please choose an option—
Driver Referrar
Craigslist
Facebook
Driver Pulse
Newspaper
Web
Other
If "Driver Referral", please enter the driver's name
If "Other", please explain
Driving Experience
Straight Truck
None
Less than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5-6 years
6-7 years
7-8 years
8-9 years
9-10 years
10+ years
Tractor and Semi-Trailer
None
Less than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5-6 years
6-7 years
7-8 years
8-9 years
9-10 years
10+ years
Tractor - Two Trailers
None
Less than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5-6 years
6-7 years
7-8 years
8-9 years
9-10 years
10+ years
Other
Licence Details
License Number
Country
—Please choose an option—
USA
Canada
Street name (As it appears on your CDL)
Apartment#
City
State
ZIP Code
License Expiration
Physical Expiration
Have you had any moving violations or traffic convictions in the past 3 Years?
Yes
No
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault) ?
Yes
No
Is this your current driver license?
Yes
No
Is this a commercial driver license?
Yes
No
Endorsements
None
Other
Tanker
Doubles / Triples
X Endorsement
HazMat
Hazmat expiration date:
Other Questions
Were you ever in the U.S. military?
Yes
No
Have you been unemployed at any time within the last 3 years? *
Yes
No
Under FMCSR 391.15, are you currently disqualified from driving a commercial motor vehicle?
Yes
No
Please provide additional detail:
Has your license, permit, or privilege to drive ever been suspended or revoked for any reason?
Yes
No
Please provide additional detail, including the dates of the suspension(s)/revocation(s):*
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Yes
No
Please provide additional detail, including relevant dates:
Within the past two years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test by an employer to whom you applied, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules?
Yes
No
Please provide additional detail about what happened:*
Date of last positive or refusal:
I authorize EXPEDITOR LLC to access the FMCSA Pre-Employment Screening Program (PSP) system and Motor Vehicle Report (MVR) to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
In the past three (3) years, have you ever been convicted of any of the following offenses committed during on-duty time [49 C.F.R. 391.15 and 49 C.F.R. 395.2]
Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more
Driving under the influence of alcohol, as prescribed by state law
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
Driving a commercial motor vehicle under the influence of any 21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.11 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
Leaving the scene of an accident while operating a commercial motor vehicle
Or any other felony involving the use of a commercial motor vehicle
Yes
No