| Personal Information
Referred By
Name
*First
*Middle
Last
Address
*Street
*City
*State
*Zip
Phone
*Home Phone
Other Phone
Fax
*Social Security Number (xxx-xx-xxxx)
Email Address
*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
A
Do you have a hazardous material endorsement
No
Safety Record
Have you had any accidents in the last 3 years?
Have you had any tickets in the last 3 years
Have you had a DWI or DUI
Have you ever been convicted of a felony
Have you ever had your license revoked or suspended
If the answer to any safety questions is yes,
state details, circumstances, and details.
Employment History
Present Employer
Address
Street
City
State
Zip Code
Phone
Contact
Position Held
Employment Dates
From (mm/dd/yyyy)
to (mm/dd/yyyy)
Previous Employer 1: List Most Recent
Company Name 1
Address
Street
City
State
Zip Code
Phone
Contact
Position Held
Employment Dates
From (mm/dd/yyyy)
to (mm/dd/yyyy)
Previous Employer 2
Company Name 2
Address
Street
City
State
Zip Code
Phone
Contact
Position Held
Employment Dates
From (mm/dd/yyyy)
to (mm/dd/yyyy)
Comments
I have read the DAC form and authorize a D A C 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.
READ
DAC FORM
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