OTR Truck Driving Application

Part 1: Personal Information

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

Email Address:

*Primary Phone:

(

)

Secondary Phone:

(

)

*Date of Birth:

*Social Security Number:

Part 2: Driving Position Information

*Position Desired:

Companies Applying For:

Apply to All Companies

Part 3: CDL Information

*License Number:

CDL Type:

CDL State:

CDL Expiration Date:

Endorsements:

	None
	Tank
	Triples
	Haz-Mat
	Doubles
	Other:

Part 4: Driving History

*DUI/DWI in the last 4 years?

Yes

*Tested positive or refused a required drug or alcohol test in the last 3 years?

Yes

*Number of Tickets in the last 3 years?

*Number of Accidents in the last 3 years?

*Felony in Lifetime:

Yes

If yes, please explain:

Part 5:Driving Experience

*OTR Experience Level

*Number of Jobs in the last 3 years?

*Trailer Experience:

	Flatbed
	Tanker
	Van
	Triples
	Piggy Back
	Specialized
	Car Hauler
	Doubles
	Reefer
	None
	Other:

Part 6: Employment History

CDL Truckstop ONLY needs your past 3 years of employment history.

*Most Recent Employer:

*Start Date (mm/dd/yyyy)?

*End Date (mm/dd/yyyy)?

City:

State:

Zip Code:

Phone:

(

)

Reason for Leaving:

Previous Employer:

Start Date (mm/dd/yyyy)?

End Date (mm/dd/yyyy)?

City:

State:

Zip Code:

Phone:

(

)

Reason for Leaving:

Second Previous Employer:

Start Date (mm/dd/yyyy)?

End Date (mm/dd/yyyy)?

City:

State:

Zip Code:

Phone:

(

)

Reason for Leaving:

Third Previous Employer:

Start Date (mm/dd/yyyy)?

End Date (mm/dd/yyyy)?

City:

State:

Zip Code:

Phone:

(

)

Reason for Leaving:

Fourth Previous Employer:

Start Date (mm/dd/yyyy)?

End Date (mm/dd/yyyy)?

City:

State:

Zip Code:

Phone:

(

)

Reason for Leaving:

Additional Info:

*Aggrement:

I agree to a background check and that all the above information is true and correct.

Call Us TODAY at ....

Phone: (501) 520-2356
Toll Free: 1-888-676-7743

Fax or Resume to ....

Fax: (501) 520-2370
Fax Toll Free: 1-888-676-7741