From:

What type of equipment do you have experience driving?

Company Name:

Company Name:

Preferred Division?

First Name:

HAZMAT

Tanker

Doubles

Triples

Can you provide proof that you are eligible to work in the United States?

Years of Tractor Trailer driving experience?

Are you an Owner Operator?

Do you currently hold a valid CDL?

Have you ever been banned by a  Steamship or rail line?

Please List and explain any accidents you have had in the last five years:

Please List and explain any criminal convictions you may have:

Have you ever failed or refused a DOT drug screen? If yes please explain:

Feel free to provide any additional information that you think may be helpful:

By checking this box, I give Associated Carriers, LP authorization to order MVR, DAC, Criminal Record Reports, and begin the Employment Verification process, including contacting my former employers to verify my dates of employment.

By checking this box I verify the validity of the information provided in this application.

Drivers License Number:

Drivers License State:

Drivers License Expiration:

Social Security Number:

Date of Birth:

What endorsements do you have on your CDL?

PREVIOUS EMPLOYMENT HISTORY

To:

State:

Zip:

From:

To:

State:

Zip:

From:

To:

State:

Zip:

From:

To:

State:

Zip:

The Department of Transportation requires that you provide your last three (3) years of employment history with NO unexplained gaps in employment.

Last Name:

Home Phone:

Middle Initial:

Street Address:

City, State, Zip Code:

Mobile Phone:

E-Mail Address:

City:

Telephone:

City:

Telephone:

Company Name:

City:

Telephone:

Company Name:

City:

Telephone:

Do you have a valid TWIC identification card?