Trucker Application Form

Name:
 

Address:
 

City:
 

State:   Zip:

Position Applying For- Check One:  
Company Driver: Owner - Operator: Owner Operator Driver:
 

Telephone:    Date of Birth:
 

Drivers License Number:  

State:    Expiration Date:

HazMat Endo?  Yes   No

Number of Moving Violations in Past 3 Years?

If Any? Give Date and Violation: 
 

Number of Accidents in Last 3 Years?

If Any Give Date, Nature of Accident, List of Injuries or Fatalities:
 

How Many Years OTR?
 

Please List Three Year Employment History:
May We Contact Your Present Employer?   Yes   No 

Date of Employment:        From:  

To: Position:
 

Employer Name:   City/ State:
 

Telephone Number:

Trailer Type:

Date of Employment:        From:  

To: Position:
 

Employer Name:   City/ State:
 

Telephone Number:

Trailer Type:

Date of Employment:        From:  

To: Position:
 

Employer Name:   City/ State:
 

Telephone Number:

Trailer Type:

Has Your License Ever Been Suspended or Revoked?    Yes No

If Yes, Give Date & Reason:
 

Have You Ever Been Convicted of a Felony?   Yes   No 

If Yes, When?

Have You Ever Refused or Failed a Substance Test?  Yes    No 
 

If Yes, When?

Have You Ever Been Convicted of a DWI / DUI?  Yes    No 

If Yes, When? 

   I certify that I personally completed this application and that all the information is true & correct. I authorize Transport One or their agents to obtain any & all information from previous employers, criminal checks and DAC Services, or consumer reports, in accordance with state and federal laws. Furthermore, I give my express consent concerning any of my past controlled substance tests. I understand that false or misleading information will disqualify me from further consideration and I am subject to immediate termination if this becomes known after employment began. Applicants not offered employment will not be provided any details, as company policy does not allow disclosure of this information. I authorize my previous employers to release any information required by Transport One and hold them harmless of all liability from release of said information.

Type Name as Signature:  

Date: