Application Type
Please select application type
Company Driver
Team
Lease Purchase
Owner Operator
Personal Information
Please enter the data below carefully so recruiters will have accurate information.
First Name
Middle Name
Last Name
Address
Address2
City
State
ZIP
Email
Telephone
(123-456-7890)
Cell Phone
Pager
Best / Quickest Method of Contact
Email
Telephone
Cell Phone
Pager
Date of birth
(MM/DD/YYYY)
SSN
Your Social Security Number is needed to run a DAC report. It will only be distributed to qualified companies receiving your application.
(123-45-6789)
Need training?
Yes
No
Student or Recent Grad?
Yes
No

If Yes:
School
Location
Do you have a CDL?
Yes
No

If Yes:
State
Class
Number
Expiration (MM/DD/YYYY)
Can you begin work immediately?
Yes
No

If no, when are you available?
(MM/DD/YYYY)
Do you have a HazMat endorsement?
Yes
No
Other endorsements?
Tanker
Double / Triple
Other
Years of truck driving experience:
None
1 - 5 months
6 - 11 months
1 year
2 years
3 years
4+ years
Have you ever had a DUI?
Yes
No

If yes, when:
(MM/DD/YYYY)
Have you ever had a felony?
Yes
No

If yes, when:
(MM/DD/YYYY)

Describe the felony:
Has your license ever been suspended?
Yes
No
Number of moving violations in last year?
0
1
2
3 or more
Number of moving violations in last 3 years?
0
1
2
3 or more
Number of accidents in last year?
0
1
2
3 or more
Number of accidents in last 3 years?
0
1
2
3 or more
Employment History
Providing at least three previous employers is encouraged. If self or unemployed, please state.
Present Employer
Name
May we contact them?
Yes
No
Date of Employment
From (MM/DD/YYYY)
To (MM/DD/YYYY)
Telephone
(123-456-7890)
Address
Address2
City
State
ZIP
Type of trailer
Number of states
First Previous Employer
Name
May we contact them?
Yes
No
Date of Employment
From (MM/DD/YYYY)
To (MM/DD/YYYY)
Telephone
(123-456-7890)
Address
Address2
City
State
ZIP
Type of trailer
Number of states
Reason for leaving / Comments
Second Previous Employer
Name
May we contact them?
Yes
No
Date of Employment
From (MM/DD/YYYY)
To (MM/DD/YYYY)
Telephone
(123-456-7890)
Address
Address2
City
State
ZIP
Type of trailer
Number of states
Reason for leaving / Comments
Third Previous Employer
Name
May we contact them?
Yes
No
Date of Employment
From (MM/DD/YYYY)
To (MM/DD/YYYY)
Telephone
(123-456-7890)
Address
Address2
City
State
ZIP
Type of trailer
Number of states
Reason for leaving / Comments
Career Information
Trailer Experience and/or Endorsements
Auto Hauling
Drop Deck
Flatbed
Other
Specialized
Doubles / Triples
Dry Van
HHG
Reefer
Tanker
Are you interested in driving regional?
Yes
No
If you are an Owner Operator, please fill out this section
Do you currently lease or own a tractor?
Yes
No

If Yes:
Year
Make
Type
Engine Size
Mileage
Tractor Weight
Wheelbase
5th Wheel Height
If no, are you interested in a lease purchase program?
Yes
No
Do you own your own trailer?
Yes
No

If Yes:
Type

The DOT requires a carrier to investigate your employment background when considering your application. This may include obtaining a consumer report from DAC Services. If you are not hired by a company based on information contained in your consumer report, you will be advised. You will also be advised of your right to obtain a free copy of the consumer report from DAC and your right to dispute the information in your report.

Your consent is necessary for a company to obtain a report from DAC.


I have read this release and grant permission for company(s) to request a consumer report on me from DAC.

I have read this release and do not grant permission for company(s) to request a consumer report on me from DAC.