Office Staff Application

Contractor Personal Information
Name*
First Middle Last
Home Phone*
Mobile Phone*
Email
SS#*
CDL#
CDL State
Current Address*
Street Address Address Line 2 City State ZIP Code
Previous Address if less than 3 years at Current
Street Address Address Line 2 City State ZIP Code
Have you ever been convicted of any crime or felony?*
- YES
- NO
If YES to the question above please provide the date
MM slash DD slash YYYY
If YES, please explain your conviction
Is there any reason you might be unable to perform the functions of the job for which you have applied?*
- YES
- NO
If YES, please explain your reason

Employment Eligibility
Do you have the legal right to work in the US?*
- YES
- NO
Military Service Record
Have you ever served in the U.S. Armed Forces?*
- YES
- NO
Branch
Dates of Service (From, To)
Honorable Discharge?
- YES
- NO
If no, please explain
Education and Training
Choose your year of education completed*
Do you have
- High School Diploma
- GED
- College Degree
List any training program or special courses that you had taken to held you as a driver.
School Name
City/State
Phone #
Dates Attended

Resume Upload
Upload Your Resume
Accepted file types: pdf, doc, docx, txt, Max. file size: 10 MB.
Resume can be in the form of a Word Document, Text File or PDF.
Employment History
All applicants must provide the following information for any previous employer during the preceding 3 years. Complete all areas below. Applicants shall also provide an additional 7 years of information for those employers for whom the applicant has operated a commercial motor vehicle. Note: Begin with your present employer and work backward in order. List complete address and phone numbers. All time must be accounted for. Leave no blanks or gaps.
Name of Employer*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date of Employment*
MM slash DD slash YYYY
End Date of Employment*
MM slash DD slash YYYY
Contact Person*
First Last
Contact Person Phone#*
Position Held*
Salary/Wage*
Reason for Leaving*
Were you subject to the FMCRs while employed?*
- YES
- NO
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?*
- YES
- NO

Contractor Personal Information