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Driver Qualifications & Info.
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Fuel Surcharge
 
 

Driver Pre-Qualification Application
*Denotes a Required Field  
*Application Type
*Applicant's Name Last   First
*Address
*City
*State/Postal Code
*Home Phone --
Cell phone:
*E-Mail Address
*Haz - Mat Endorsement? Yes No
*Have you EVER been denied a license, permit, or privilege to operate a motor vehicle? Yes No
*Has your motor vehicle operator's license, permit, or privilege EVER been suspended or revoked? Yes No
*Have you EVER been disqualified from driving a motor vehicle under the D.O.T regulations? Yes No
*Have you EVER been convicted or do you have charges pending for driving under the influence of alcohol or drugs? Yes No
*Have you EVER been convicted or do you have charges pending for possession, sale, or use of narcotic drugs, amphetamines, or a derivative? Yes No
*Have you EVER been convicted or do you have charges pending of a serious traffic violation, such as careless or reckless driving or willful reckless driving, etc.? Yes No
*Have you EVER been convicted or do you have charges pending for a felony or misdemeanor? Yes No
*Can you begin working immediately? Yes No
*Number of Accidents/Incidents in the last 3 years?
*Number of Tickets in the last 3 years?
*How many years driving experience OTR do you have?
*In the last 5 years what is the longest time span you have had with one company?
What year model is your truck?
*Most Recent Employer:  
Location City:    State:

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