Drive For Us -

Application Date(Required)

Email(Required)

Name(Required)

First Middle Last

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth(Required)

Social Security #(Required)

Recent Residences

Have been at your current address for less than 3 years?(Required)

Yes

No

Please list all other residences over the last 3 years.

Past Address 1

Street Address City State / Province / Region ZIP / Postal Code Country

Dates Lived at Past Address 1 (From Date/To Date)

Past Address 2

Street Address City State / Province / Region ZIP / Postal Code Country

Dates Lived at Past Address 2 (From Date/To Date)

Driver's License Information

Include all licenses held in the last 3 years.

State(Required)

Number(Required)

Expiration Date(Required)

State

Number

Expiration Date

State

Number

Expiration Date

Experience

Type of Vehicle

Dates

Mileage Driven

Type of Vehicle

Dates

Mileage Driven

Type of Vehicle

Dates

Mileage Driven

To Be Read and Signed by the Applicant

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s); and for that previous employer(s) to re-send the corrected information to the prospective employer; and the right have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Driver employees who have previous Department of Transportation (DOT) regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at any time, including when applying or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then then the five (5) business days deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within 30 days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.

Certification(Required)

My signature certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Name(Required)

Date Signed(Required)

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