Items marked with * are required
Address Line 2
*Date of Birth
*Home Phone Number
*Drivers License Type
CDL - HazMat
CDL - Double/Triple
CDL - Passenger
CDL - Tanker
To select more than one item hold down Ctrl while selecting.
*Driving Position Applying For:
*How many years of verifiable
experience do you have driving a tractor trailer?
More than 20 Years
List all moving violation in last
List all accidents you have been
involved in the last 36 months regardless of fault or type of vehicle:
Injury? Fatalities? Description
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
*Reason for leaving
Unemployment period from
Reason for leaving
Reason for leaving
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.