Online Company Driver Application

Personal Information:

Referrer:

First Name:

Middle Name:

Last Name:

Home Phone Number:

Other Phone Number:

Fax Number:

Email Address:

Address:

City:

State:

Zipcode:

Best time to contact you: Within 5 days of posting

Driver License Information:

License Number:

State Issued:

Expires: mm/dd/yyyy

Birthdate: mm/dd/yyyy

Year Vefiable Tractor Trailer Experience:

Endorsements:

What is your current CDL Class:

Do you have a hazardous material endorsement?

Safety Record

Have you had...

any accidents in the last 3 years?

any tickets in the last 3 years?

a DWI or DUI?

ever been convicted of a felony?

ever had your license revoked or suspended?

ever been disqualified by federal regulations?

Safety Details: If the answer to any safety question is yes, please state details and circumstances

Employment History:

Present Employer

Company:

Contact Name:

Address:

City:

State:

Zipcode:

Phone:

Position:

Start Date: mm/dd/yyyy

End Date: mm/dd/yyyy

Previous Employer 1 (List most recent)

Company:

Contact Name:

Address:

City:

State:

Zipcode:

Phone:

Position:

Start Date: mm/dd/yyyy

End Date: mm/dd/yyyy

Previous Employer 2

Company:

Contact Name:

Address:

City:

State:

Zipcode:

Phone:

Position:

Start Date: mm/dd/yyyy

End Date: mm/dd/yyyy

Additional Information:

Comments:

I have read the DAC form and authorize a DAC background check:

Disclaimer
I certify that I personally completed this application and that all of the information is true and correct. I hereby authorize Road Scholar Transport to conduct, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold Road Scholar Transport harmless of all liability for providing this application for my use.