Part 1: Personal Information

*First Name:
*Last Name:
*Address:
*City:
*State:
 
*Zip Code:
Email Address:
*Primary Phone:
( )   -
Secondary Phone:
( )   -
*Date of Birth:
*Social Security Number:

Part 2: Driving Position Information

*Position Desired:
 

Part 3: CDL Information

*License Number:
If you do not have a CDL, please enter you personal drivers license number.
CDL Type:
CDL State:
 
CDL Expiration Date:
Endorsements:
None
Tank
Triples
Haz-Mat
Doubles
Other:

Part 4: Driving History

*DUI/DWI in the last 5 years?
Yes No
*Tested positive or refused a required drug or alcohol test in the last 3 years?
Yes No
*Number of Tickets in the last 3 years?
 
*Number of Accidents in the last 3 years?
 
*Felony in Lifetime:
Yes No
If yes, please explain:

Part 5:Driving Experience

*OTR Experience Level
 
*Number of Jobs in the last 3 years?
 
*Trailer Experience:
Flatbed
Tanker
Van
Triples
Piggy Back
Specialized
Car Hauler
Doubles
Reefer
None
Other:

Part 6: Employment History

CDL Truckstop ONLY needs your past 3 years of employment history.
*Most Recent Employer:
*Start Date (mm/dd/yyyy)?
*End Date (mm/dd/yyyy)?
City:
State:
 
Zip Code:
Phone:
( )   -
Reason for Leaving:
 
*Number of States Covered?

Previous Employer:
Start Date (mm/dd/yyyy)?
End Date (mm/dd/yyyy)?
City:
State:
 
Zip Code:
Phone:
( )   -
Reason for Leaving:
 
Number of States Covered?

Second Previous Employer:
Start Date (mm/dd/yyyy)?
End Date (mm/dd/yyyy)?
City:
State:
 
Zip Code:
Phone:
( )   -
Reason for Leaving:
 
Number of States Covered?

Third Previous Employer:
Start Date (mm/dd/yyyy)?
End Date (mm/dd/yyyy)?
City:
State:
 
Zip Code:
Phone:
( )   -
Reason for Leaving:
 
Number of States Covered?

Fourth Previous Employer:
Start Date (mm/dd/yyyy)?
End Date (mm/dd/yyyy)?
City:
State:
 
Zip Code:
Phone:
( )   -
Reason for Leaving:
 
Number of States Covered?
Additional Info:

Job ID # (if applicable):
*Aggrement:
I agree to a background check and that all the above information is true and correct.