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
Date Format: 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.
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*
Date Format: MM slash DD slash YYYY
End Date of Employment*
Date Format: 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