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First Name:   MI:  Last Name: 

Address: 

Address 2: 

City:  State:  Zip Code: 

Home phone: 

Mobile phone: 

E-mail:  I would like to receive employment opportunities via email.

Are you a Veteran?       Yes No

Are you a Driver or a Mechanic?

Driver Mechanic

Do you have a valid commercial drivers license (CDL)? Yes No
CDL License #
State:
What CDL classification do you have? A B C
Do you have Over the Road Experience (OTR)? Yes No
How many years of experience do you have? 1 year 2 years 3+ years
What type of driving experience do you have? Doubles/Triples
Hazardous Materials
Flatbeds
Tankers
Dump
Other
Are you an Owner Operator? Yes No
Do you own your own truck? Yes No
Are you eligible to work in the United States? Yes No
Are you at least 21 years old? Yes No
Have you been convicted of any felonies in the last 10 years? Yes No
Are you currently on probation or parole? Yes No
Do you have any pending court dates? Yes No
Have you been convicted of any misdemeanors in the last 10 years? Yes No
Have you had any DUI's in the last 10 years? Yes No
Have you had any moving violations in the last 3 years? Yes No
Have you been charged and convicted of reckless driving in the last 3 years? Yes No
Please name the companies you have worked for in the last 3 years.
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How many months of mechanic education do you have?
Do you have any certifications? Automotive Collision Repair Diesel High Performance ASE Other N/A
How many years have you worked as a mechanic?

Do you have experience working on the following?
  • Diesel Engine Repair
  • Automotive Engine Repair
  • Hydraulic Systems
  • Emissions Control Systems
  • Self Lubricating Systems
  • Suspension and Steering
  • Electrical
  • Drive Train
  • Trailer Repair
  • Heating and Air
  • Other
  • N/A
What CDL classification do you have? A B C Non-Trucking License N/A
Do you have your own tools? Yes No

Please name the companies you have worked for in the last 3 years.

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