Items marked with * are required

*Last Name    *First Name    Mid Init    Suffix    Maiden Name

*Street Address

Address Line 2

*City    *Home State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    *Zip Code

*Date of Birth

*Home Phone Number    Email Address

*Drivers License Type
CDL CDL - HazMat CDL - Double/Triple CDL - Passenger CDL - Tanker Operator

To select more than one item hold down Ctrl while selecting.

*Driving Position Applying For: Experienced Driver Owner Operator School Graduate/Trainee

*How many years of verifiable experience do you have driving a tractor trailer?  0-6 Months 7-12 months 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11-15 Years 16-20 Years More than 20 Years

List all moving violation in last 36 months:

       Date                      Violation                                     Location

1) 

2) 

3) 

4) 

5) 

List all accidents you have been involved in the last 36 months regardless of fault or type of vehicle:

      Date               Tows?                   Injury?               Fatalities?                 Description

1)

2)

3)

4)

ALL DRIVER APPLICANTS TO DRIVE IN INTERSTATE COMMERCE MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING 3 YEARS. LIST COMPLETE MAILING ADDRESS, STREET NUMBER, CITY, STATE, AND ZIP CODE.

Current or Most Recent Employer

*Employer Name

*Position   

*Start Date   *End Date   *Reason for leaving

Unemployment period from to

Unemployment period from to

Unemployment period from to

Unemployment period from to

Unemployment period from to

In connection with my application for employment (including contract for services) with you, I understand that a consumer report, which may contain public record information, is being requested from DAC Services, Tulsa, Oklahoma. This report may include the following types of information:  names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies and state provided driving records.

I authorize, without reservation, any party or agency contacted by DAC or CoreTrans, LLC to furnish the above-mentioned information.

I further certify that I personally completed this application and that all of the information is true and accurate.  I authorize CoreTrans, LLC to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by CoreTrans, LLC, including but not limited to information required by 391.23 of the Motor Carrier Safety Regulations, and hold them harmless of all liability from the release of said information.