* indicates a required field
* Name: * Name:
Drivers License Number: Drivers License Number:
Address: Address:
City: City:
State: Select StateAL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareDC - District Of ColumbiaFL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaPR - Puerto RicoRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVT - VermontVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - Wyoming
Zip Code: Zip Code:
* Email: * Email
Telephone: Telephone
Date Available: Date Available
Are you an owner operator?: Are you an owner operator?:
Total years of CDL-A driving experience?: Total years of CDL-A driving experience?:
Years of van/reefer experience?: Years of van/reefer experience?:
How many chargeable accidents in last 3 years?: How many chargeable accidents in last 3 years?:
How many moving violations in last 3 years?: How many moving violations in last 3 years?:
License ever suspended?: License ever suspended?:
Reckless driving in last 7 years?: Reckless driving in last 7 years?:
Felony Convictions?: Felony Convictions?:
DUI Charges?: DUI Charges?:
Hazmat Certified?: Hazmat Certified?:
Months CDL-A driving in last 3 years?: Months CDL-A driving in last 3 years?:
Number of jobs in last 3 years?: Number of jobs in last 3 years?:
* Current/Most Recent Employer: * Current/Most Recent Employer:
Are you presently employed?: Are you presently employed?:
May we call your current employer?: May we call your current employer?:
Employer Address: Employer Address:
Employer Phone: Employer Phone
Employer Phone Type Cell Home Work
Position Held: Position Held:
From Date: From Date
To Date: To Date
* Why do you want to change employers?: * Why do you want to change employers?
* Second Last Employer: * Second Last Employer:
* Why did you leave?: * Why did you leave?
* I certify that I personally completed this application and that all of the information is true and correct. I authorize Aberdeen Express to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Aberdeen Express and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Aberdeen Express by whatever means is most expedient. * I certify that I personally completed this application and that all of the information is true and correct. I authorize Aberdeen Express to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Aberdeen Express and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Aberdeen Express by whatever means is most expedient.: I agree
