APPLICATION APPLICATION Driver Pre-Application First Name * Last Name * Street 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 / Postal Code * Phone Number * Cell Phone Email Address Date of Birth * Social Security Number * Position Appyling For Student or No Tractor Trailer Experience Between 30 Days and 3 Months Experience More Than 3 Months Experience Owner Operator/Fleet Owner Current or Most Recent Driver's license Number * Name of Truck Driver Training School State you attend(ed) Truck Driving School Name of Your Current or Most Recent Employer City of Your Most Resent Employer State/Province of Your Most Recent Employer Was this a Tractor Trailer Job? Yes No How many moving violations have you recieved in the last 5 years? * How many preventable accidents have you been involved in within the last 5 years? * Have you ever been convicted of or do you have any currently pending charges for a DUI, DWI, or any other alcohol related offenses. * Yes No Have you ever been convicted of or do you have any currently pending carges for Reckless Driving? * Yes No Have you ever tested positive for drugs or alcohol or refused a drug or alcohol test? * Yes No Has your license ever been suspended? * Yes No In the event your license has ever been suspended, please explain. Applicant Disclaimer: As part of the application process, we will be doing a complete background investigation. This includes obtaining consumer reports about you from HIRERIGHT SOLUTIONS, INC. If we decide not to hire you based on information contained in these reports, we will tell you about your right to obtain a free copy of the report. We will also tell you how to dispute the accuracy of the report. Remember that HIRERIGHT SOLUTIONS, INC. only reports the information to us. They do not make the decision about hiring you. Be advice that the information in your application will be used and that past or present employers will be contacted for purposes of investigation as required by federal DOT regulations. You are hereby notified of your due process rights as specified in 391.23i(1) of the FEDERAL MOTOR CARRIER SAFETY REGULATIONS. 1: The right to review information provided by previous employers. 2: The right to have errors in the information corrected by the previous employer and for that employer to re-send the corrected inforamtion to the prospective employer. 3: The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Do we have your permission to request your consumer reports? * Yes No