Please Select The Carriers To Receive Your Application.
All-State Express
ASAP Express, Inc.
Bolt Express
UPS Expedite
Diamond Delivery
Express-1
Jung Express
Premium Transport Logistics
CTX, Inc.
TranStewart Trucking
Dynamex Expedite
Rocket Expedited
TST Expedited Services, Inc.
Taylor Made Express
Spears Transfer & Expediting
 Metro Express
Try Hours
Landstar Express America
Panther II
Tri-State Expedited Service
FedEx Custom Critical
Nations Express
Express Way, Inc.
On Time Express
Expediter Services
RJR Transportation Services
DMW Expedite
A. Blair Enterprises,Inc.
Prestige Expedite
Rapid Service, Inc.

Items in red are required.

Your Contact Information
Your Full Name:
Address:
Address Line 2:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Pager:
Fax:
Email Address:
Date Of Birth:
Country Of Citizenship?
If not a U.S citizen, do you have
a Permanent Resident card? :  Yes No
Social Security #:


Your Driving History
Driver License #:
Driver License State:
Driver License Exp.:
Has your driver's license ever been suspended
for any reason?   Yes No
Have you had any other Driver's Licenses besides your
current one above in the last 3 years?:   Yes No
List all Driver's Licenses besides above you have held in the last 3 years.
Please List States and Driver's License Numbers
Your Status:
Truck Type:
Truck Year:
Do you have a CDL? Yes:A  Yes:B  Yes:C
HazMat Endorsement? Yes   No
Number of moving violations in the last 3 years:
Number of accidents in the last 3 years:
Have you ever had a DUI / DWI?: Yes No
If YES, When
Have you ever failed / refused a drug test? Yes No
If YES, When
Have you ever been convicted of a crime? Yes No
If YES, please provide full details


Your Driving Experience
Present Employer
Present / Last Employer:
Dates Employed:
Employer's Address
Please Include street,
city, state & zip code
Employer's Phone:
Position Held:
Reason For Leaving:
If you were a driver, please provide the following information:
Equipment: Straight Truck   Semi   Other
If Other, Please specify:
If Tractor, What Size:

Previous Employer
Previous Employer:
Dates Employed:
Employer's Address
Please Include street,
city, state & zip code
Employer's Phone:
Position Held:
Reason For Leaving:
If you were a driver, please provide the following information:
Equipment Straight Truck   Semi   Other
If Other, Please specify:
If Tractor, What Size:

Previous Employer 2
Previous Employer:
Dates Employed:
Employer's Address
Please Include street,
city, state & zip code
Employer's Phone:
Position Held:
Reason For Leaving:
If you were a driver, please provide the following information:
Equipment: Straight Truck   Semi   Other
If Other, Please specify:
If Tractor, What Size:

Statement of Understanding
I certify that I personally completed this application and that all of the information is true and correct. I authorize the above carriers to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officer or their agent, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by the above carriers and hold them harmless of all liability from release of said information. I have read and understand the above statements and acknowledge by affixing my digital signature below.

I have read and understand the above statements    YES   NO
Your Full Name: