Transportation Education & Economic Network                
                                              The Transportation Employer Partners will require a hand written application to be on file prior to beginning orientation.
                                             Applicants are considered without regard to race, creed, color, sex, religion, age, national origin or disability.

Position: Tractor Trailer Operator

Student Driver

Experienced Driver

NAME: 

Last Name: 

First Name: 

Middle Name: 

Social Security #: 

ADDRESS:

Street:

City: 

State: 

Zip Code: 

PERSONAL:

Phone Number:

Cell Number: 

E-Mail (optional): 

Date Of Birth: 

CURRENT DRIVERS LICENSE INFORMATION:

License Number: 

State:   Expires:

License Type: 

Availability Date:

List all drivers licenses held in past five (5) years

STATE

LICENSE NUMBER

TYPE

EXP. DATE

DRIVING RECORD: TRAFFIC CONVICTIONS/FORFEITURES

DATE

LOCATION (STATE)

CHARGE

PENALTY

ACCIDENT REPORT: Accidents with vehicles for the past five years

Date

Type Of
Vehicle

Nature of Accident

Preventable
Non-Preventable

Fatalities

Injures

Amount of
Damage

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes

No

 Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

No

 Have you ever had any license, permit or privilege suspended or revoked?

Yes

No

 Have you ever been convicted or charged for driving under the influence of alcohol or drugs?

Yes

No

 Have you ever been convicted or charged for possession, sale, or use of a narcotic drug, amphetamine or derivative?

Yes

No

 Have you ever been refused liability insurance?

Yes

No

 Have you ever been convicted or charged of a felony?

Yes

No

 Have you ever been convicted or charged of a misdemeanor?

Yes

No

 Have you ever been disqualified to drive by Federal Regulations?

Yes

No

 Have you ever been refused a security bond?

YES Answers: state details, circumstances & date: 

MILITARY STATUS:

Have you ever served in the U.S Armed Forces?

Yes      No      Branch:

DATES SERVED:

From:

To: 

DD214 Narrative reason for discharge: Honorable Dishonorable General 
Other/Explain 

EMPLOYMENT HISTORY: (3) years STUDENT DRIVERS (10) years EXPERIENCED DRIVERS

Current Employer:

Name:

Address:

City State & Zip:

Phone Number: 

Supervisor:

Date of Employment:

From:   To:    

May we contact you current employer: Yes No

Number of states driven in:

Reason for leaving:

2nd Last Employer:

Name:

Address:

City State & Zip:

Phone Number: 

Supervisor:

Date of Employment:

From:   To:

May we contact you current employer: Yes No

Number of states driven in:

Reason for leaving:

3rd Last Employer

Name:

Address:

City State & Zip:

Phone Number: 

Supervisor:

Date of Employment:

From:     To:

May we contact you current employer: Yes No

Number of states driven in:

Reason for leaving:

4th Last Employer

Name:

Address:

City State & Zip:

Phone Number: 

Supervisor:

Date of Employment:

From:     To:

May we contact you current employer:  Yes  No

Number Of states driven in:

Reason for leaving:

5th Last Employer

Name:

Address:

City State & Zip:

Phone Number: 

Supervisor:

Date of Employment:

From:   To:

May we contact you current employer: Yes No

Number of states driven in:

Reason for leaving:

By submitting this application, I certify that all the information on this form is correct and complete to the best of my knowledge. I understand that the information in this application will be used and that prior positions will be contacted for purpose of investigation required by 391.23 of the Motor Carrier Safety regulations. I hereby authorize release of any information on this application and release said persons, previous employers and Transportation Education and Economic Network from any liability or damages.

ACCEPT: Yes I agree to terms above

DATE:

NAME:

DECLINE: No I do not agree to terms above

DATE:

NAME: