Driver Employment Application

Personal Information
First Name :
Middle Initial
Last Name :
Address 1 :
Address 2 :
City / State / Zip Code	/ /
Email address :
Social Security Number :
Date of Birth :	(Minimum 23 years of age)
Years of CDL driving experience :	(Minimum 2 years of experience)
Which Class?	- Select One - Class AClass B
Phone Number :
Best time to call :
Do we have your authorization to run an MVR?	Yes No
License Number :
State :
CDL :	A B
Hazardous Materials :	Yes No
Which of the following types of positions would you be interested in?
Local (home same day) Food service         Regional (500 mile radius) Steel / Aluminum         Over the Road (out more than one night) General Commodities         Yard Jockey                 Straight Truck (Class B)         Drop and Hook Dry Van (Class A)         Palletized Freight Reefer Van (Class A)         Hand Unload (Multi-stop Delivery) Flatbed / Covered Wagon (Class A)
License Information
Number of moving violations in the past 3 years :
Number of accidents in the past 3 years :
Has your license ever been suspended or revoked?	Yes No
If yes, when
Why?
Have you ever been convicted of a DUI/DWI?	Yes No
If yes, when?
Have you ever been convicted of reckless operation?	Yes No
If yes, when?
Have your ever been convicted of a misdemeanor or felony?	Yes No
If yes, explain :
Have you ever tested positive for drugs/alcohol for employment testing?	Yes No
Do you have any charges pending?	Yes No
If yes, explain :
Do you have a current DOT physical?	Yes No
Military service?	Yes No
Type of discharge :
Employment History
Current Employer :	None
Dates Employed :	From To   (mm/dd/yyyy)
Address 1 :
Address 2 :
City / State :	/
Contact :
Phone :
Fax :
Job Description :
Equipment Driven	None Straight Truck Reefer Trailer Cargo Van Flat Trailer S/A Tractor Open Top T/A Tractor Straight Reefer Tractor Trailer Other
OTR, Regional or Local?
Reason for leaving :
May we contact your current employer?	Yes No
Previous Employer 1 :	None
Dates Employed :	From To   (mm/dd/yyyy)
Address 1 :
Address 2 :
City / State :	/
Contact :
Phone :
Fax :
Job Description :
Equipment Driven :	None Straight Truck Reefer Trailer Cargo Van Flat Trailer S/A Tractor Open Top T/A Tractor Straight Reefer Tractor Trailer Other
OTR, Regional or Local?
Reason for leaving :
Previous Employer 2 :	None
Dates Employed :	From To   (mm/dd/yyyy)
Address 1 :
Address 2 :
City / State	/
Contact :
Phone :
Fax :
Job Description :
Equipment Driven :	None Straight Truck Reefer Trailer Cargo Van Flat Trailer S/A Tractor Open Top T/A Tractor Straight Reefer Tractor Trailer Other
OTR, Regional or Local?
Reason for leaving :
Do you accept the information in this application for employment to be true ? Yes No By signing your initials below, you agree for AIM Nationalease to use you social security and license numbers to perform background investigations (MVR, DAC, etc…)     Your Initials