Drivers Online Application for Employment
All driver applications will be kept active for 60 days. To check the status of your application please call 1-800-422-4799
*Last Name *First Name *Mid Init Suffix
Maiden Name
*Street Address
Address Line 2
*City *ST 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
*Social Security Number *Date of Birth
*Home Phone Number Email Address
*Previous Addresses:
(List all previous addresses for the past five years)
*Are you eligible to work in the United States? Yes No
*Are you available to work fulltime Yes No
*Notify in case of emergency: Name *Address
*City *St 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 *Phone
*Relationship
*Drivers License Number *Expiration Date
*Drivers License 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
*Drivers License Type
CDL CDL - HazMat CDL - Double/Triple CDL - Passenger CDL - Tanker Operator
(To select more than one endorsement hold the CTRL key while you click on your endorsements)
*List all driver licenses you have held in the past 36 months
(include state, type, and expiration date):
*How long have you held a CDL/Chauffeur's License? 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
Truck driving school name Location
Graduation Date
*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
*How did you hear about CoreTrans? Company Driver Newspaper Tractor Other Referred by:
*Have you ever been employed by CoreTrans? Yes No
If yes when? From until
*Have you ever been convicted of a misdemeanor? Yes No
If yes, please provide date(s) and explanation below:
Explain misdemeanor convictions here, (exclude moving violations).
*Have you ever been convicted of a felony? Yes No
Explain felony convictions here.
*Have you ever been convicted of a DUI, DWI, careless or reckless driving? Yes No
Explain DUI, DWI, careless or reckless driving convictions here.
*Have your driver's license ever been suspended or revoked? Yes No
Explain suspensions here.
*Have you ever failed a drug test? Yes No
f yes, please provide date(s) and explanation below:
Explain positive drug test results here.
*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:
*Have you ever served in the U.S. Armed Forces? Yes No
*If yes, what branch? Air Force Army Coast Guard Marines Navy Date entered Date Discharged
*Type of discharge Reserve status
*Do you have a current D.O.T. Physical Certificate? Yes No
*If yes, name of doctor *Address
*Exam Date
Employment History
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.
*Employer Name
*Address
*City *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
*Phone *Position
*Start Date *End Date *Reason for leaving
*Supervisor
*May we contact your current employer? Yes No
*Equipment Operated *Rate of Pay per
Unemployment period from to
Employer Name
Address
City 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
Phone Position
Start Date End Date Reason for leaving
Supervisor
Equipment Operated Rate of Pay per
DRIVER NOTIFICATION AND RELEASE
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.