Jim's Trucker Recruiting
  
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Personal Information
Contact Information
Full Name:
Address:
City:
State: Zip:
Day Phone:    
Night Phone:    
Email: Best time to call:
SSN:
Date of Birth #:    
CDL Information
CDL Number:
Issue State: Expiration Date:
Check all that apply to your current CDL:
Class A Class B Class C Hazmat
Tanker Double
Driver Information
I am a ... (Check all that apply. One field must be chosen):
Company Driver Owner Operator Student    
Check any teaming preference that applies:
Single Team Husband and Wife    
Check all that apply:
I am interested in a lease/purchase?
I am a Driving School Graduate
 
Experience and Preference
Total OTR years:
 
Trailer Type Experience and Preference
TRAILER TYPE EXPERIENCE PREFERS
Flatbed
Van
Tanker
Reefer
Hazmat
Car Hauler
Household Goods
Specialized
Double/Triple
Regional Driving Preference
Check all that apply:
North West Midwest North East
South West     South East
 
Employment History
Current Employer
Employer name :
Address Phone
City State Zip
Start date
 
 
 
Previous Employer#1
Employer name :
Address Phone
City State Zip
Start date
End date
 
Previous Employer#2
Employer name :
Address Phone
City State Zip
Start date
End date
 
Previous Employer#3
Employer name :
Address Phone
City State Zip
Start date
End date
Owner Operator
(Not an Owner Operator? Please skip this section)
Tractor
Do you own your tractor?    Yes   No
 
Driving History
Accidents
Number of accidents (last 3 years)
 
Tickets
Number of tickets received (last 3 years)
Have you ever received a ticket for reckless driving? Yes   No
 
Criminal Record
    If so, when...
Have you ever been convicted of a felony? or misdemeanor? Yes   No
Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes   No
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes   No
Has any license, permit or privilege ever been suspended or revoked? Yes   No
Have you ever been refused any type of insurance or been denied bonding? Yes   No
Have you ever tested positive on a drug screen? Yes   No
 
  Comments
By submitting this application, I certify that I personally completed this application and that all of the information is true and correct.
 

  

 
 		  
   
   
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