Apply for Commerical Driver

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Commerical Driver
ID:GEN001
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Country:
* Zip:
* Cell Phone #:
Home/Other Phone #:
* Email:
Source:
How did you hear about us?
* License Class:
Specific Job ID :
Application Information
Recruiter:
Contractor/Employee Paid Date::
Truckers America Online Driver Application
Please fill out the application to the best of your ability! If you have any questions, please contact your recruiter. If you have yet to speak to a recruiter, please contact our main office at: 877-789-5778.
PERSONAL INFORMATION
* Date of Birth:
* SSN#:
* Do you Live in the United States?
Yes   No
* Years at Current Residence?
If '5+ Years' was NOT selected for the previous question, please list your address prior to your current address:
* Can we, as well as any companies that you decide to move forward on, text you regarding future opportunities?:
* Highest Level of Education:
Reference #1 Name:
Reference #1 Relationship:
Reference #1 Phone Number:
Reference #2 Name:
Reference #2 Relationship:
Reference #2 Phone Number:

MILITARY SERVICE
* Were you ever in the military?
Yes   No
If no to the above question, please skip to the next section: License & Driving Information.
If yes, what branch?
Start Date:
End Date:
Honorable Discharge?
Yes   No

LICENSE & DRIVING INFORMATION
* License Class:
* Drivers License State:
* Drivers License Number:
* Drivers License Expiration Date:
* Physical Expiration Date:
* Endorsements:
* Hold CTRL to select multiple items
Other Endorsements (If Applicable)
Hazmat Expiration Date (If Applicable):
* Have you held any additional licenses in the last 3 years?
Yes   No
If yes to the above question, please provide the additional license information
* Do you possess a valid TWIC?
Yes   No
TWIC Expiration Date (If Applicable)
* Do you possess a valid Passport?
Yes   No
Passport Expiration Date (If Applicable)
* Do you have a Sea Link card?
Yes   No
* Which of the following do you have experience with?
* Hold CTRL to select multiple items
* What shift do you prefer?
* Hold CTRL to select multiple items

OWNER / OPERATOR INFORMATION
* Are you an owner operator?
Yes   No
If no to the above question, please skip to the next section: Driver Training School.
Number of trucks owned:
Truck Year
Truck Make
Truck Model
Do you own the truck outright?
Yes   No
Empty Gross Weight:Wheel Base:
5th Wheel Height:Stack Height:

DRIVER TRAINING SCHOOL
* Have you ever attended a driving school?
Yes   No
If no to the above question, please skip to the next section: Employment Information.
School Name:
School City:
School State:
Graduation Date:

EMPLOYMENT INFORMATION
Please list your most recent employer, self-employment, or contract work completed. If you have no recent employment, please list your most recent schooling attended in the employment section below.
EMPLOYER 1 (Most Recent Employer)

Dates Employed Employer Name & Address Employer Contact Info
From:
*

To:
*
Name:
*

Address:
*
City:
*
State:
*
Zip:
*
Phone:
*

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
*
Yes   No
*
*
# of Days Out on the Road # of States Driven Trailer Length
*
*
*
Reason for leaving? Please Explain: Additional Comments?
*
*
* May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
*
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

Employer 2

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 3

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 4

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 5

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 6

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 7

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 8

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 9

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 10

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 11

Dates Employed Employer Name & Address Employer Contact Info
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain: Additional Comments?
May we contact this employer?
Yes   No

Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class-A or B CDL Jobs) within the last 3-10 years?
Yes   No

If yes to the above question, please click the 'Add another Employer' button!

EMPLOYER 12

Dates Employed Employer Name & Address Employer Phone & Fax
From:

To:
Name:

Address:
City:
State:
Zip:
Phone:

Fax:
Operate a CMV? Vehicle/Truck Driven Trailer Type Hauled
Yes   No
# of Days Out on the Road # of States Driven Trailer Length
Reason for leaving? Please Explain Reason for Leaving Additional Comments?


* Have you been unemployed at any time during the last three (3) years for a period greater than ninety (90) days?
Yes   No
If yes to above question, please provide dates and reason.
TRAFFIC CONVICTIONS
* Do you have ANY traffic convictions within the last 5 years?
Yes   No

TRAFFIC CONVICTION 1

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 2

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 3

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 4

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC CONVICTION 5

Date of Conviction Type of Vehicle Operating Conviction Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
Additional Explanation: Supporting Documents  
 


TRAFFIC ACCIDENTS
* Do you have ANY vehicle accidents within the last 5?
Yes   No

ACCIDENT 1

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes   No

Supporting Documents


ACCIDENT 2

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 3

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 4

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


ACCIDENT 5

Date of Accident Accident Type Vehicle Type
Personally Operated Vehicle (POV)
Commercial Motor Vehicle (CMV)
DOT Recordable? Preventable/Non-Preventable? Additional Explanation
Yes
No

Supporting Documents


BACKGROUND HISTORY
Please answer the following questions as accurately as possible including date, charge, and any additional comments you'd like. Please note that any previous convictions will not result in being denied employment. Providing the best explanation possible will allow us to best help you find a job!
* Do you have any felony convictions within the last ten (10) years?
Yes   No
If yes to the above question please explain.
* Do you have any misdemeanor convictions within the last five (5) years?
Yes   No
If yes to the above question please explain.
* Have you ever had a drug conviction?
Yes   No
If yes to the above question please explain.
* Have you ever been charged with DUI/DWI?
Yes   No
If yes to the above question please explain.
* Have you ever had your license suspended, denied and/or revoked, or refused liability insurance?
Yes   No
If yes to the above question please explain.
* Have you ever been charged with Reckless Driving or Driving to Endanger?
Yes   No
If yes to the above question please explain.
* Have you ever tested positive on a pre-employment drug screen or a random drug screen?
Yes   No
If yes to the above question please explain.

CONFIRMATION & SUBMISSION
I confirm that the information submitted via this 'Truckers America Online Application' is true and correct to the best of my knowledge.

* Signature (Type Full Name):
* Date:

Please enter the last four digits of your Social Security number to confirm your submission:
*


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