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SECURITY - your SS#, Address and CDL License Number are NOT asked for on this questionnaire. |
Okay... let's get started.
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First/Last Name: |
Age: |
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City: |
State:
Zip: |
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Home Phone: |
Cellphone:
[ format: 000-000-0000 ] |
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Email Address: |
(NEEDED to send the paperwork, this does not leave our file system!) |
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How To Contact You: |
By Any Method
Home Phone
Cellphone
Email (provided above) |
HINT: The easier/quicker it is to contact you, the sooner you find a decent position!
Most dedicated/regional positions are very time sensitive and fill quickly.
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Okay, Let's Briefly Cover Your OTR/CDL Information. |
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OTR Experience: |
How many months of OTR (5+ states/53' van) driven in last 36 months?
How many months of OTR (5+ states/53' van) driven in last 12 months? |
Number of Different
States Driven in CMV: |
Last 3 years (number, not names/initials)
Last 12 months (number, not names/initials) |
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Date Last Drove OTR: |
[ format: 00/00/0000 ]
How Many Jobs in last 3 yrs |
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Verifiable Work History: |
10+ Yrs
No
(includes CDL & non-CDL employment history)
(Company/Phone/Address will be needed on paperwork to verify work history.) |
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Class A License: |
Yes
No
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Hazmat Endorsement: |
Yes
No |
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Expiration Date: |
/
Is CDL Licensed in “State of Residence”?
Yes
No |
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CDL Equipment Driven: |
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Okay, Let's Briefly Cover Your CMV/MVR/Criminal Information.
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DAC/MVR Questions: |
( CMV = Commercial Motor Vehicle / POV = Personally Owned Vehicle )
Had a DUI/DWI Conviction?
No
Yes-CMV
Yes-POV
If Yes, How Old?
Under 5 yrs
Over 5 yrs
10+ yrs
If Yes, Had More Than One DUI/DWI?
No
Yes
Had a License Suspended/Revoked?
No
Yes
(If Yes - briefly explain below.)
Had an Accident?
No
Yes-CMV
Yes-POV
(If Yes - briefly explain below.)
If Yes, Were You At Fault, Ticketed or Charged?
No
Yes
Ever Tested Positive/Refused a Drug/Alcohol Test in a CMV?
No
Yes
Ever Been Terminated Over a CMV/Company Policy?
No
Yes |
Briefly Explain Any
License/Driving,
Accident/Ticket
Issues: |
(Charge Date / Charge / State / Results)
(An older/lesser charge is usually not a problem.)
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Felony Conviction: |
No
In Last 5 yrs
In Last 10 yrs
10+ yrs Old |
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Misdemeanor Conviction: |
No
In Last 5 yrs
In Last 10 yrs
10+ yrs Old |
Briefly Explain Any
Conviction
Issues: |
(Charge Date / Charge / State / Results)
(An older/lesser charge is usually not a problem.)
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Okay, Let's Briefly Cover Your Preferred CMV Position. |
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Position Wanted: |
Solo Company Driver
Team Company Driver
Owner/Operator
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Run Wanted: |
OTR Extended
OTR
Regional/Dedicated
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Equipment: |
(At this time, most of our positions are: 53' Dry Van, Drop-n-Hook, No-touch.) |
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Comments/Concerns:
(additional information) |
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