Driver Application

Personal Information

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regards to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

* REQUIRED FIELD

* First Name

* Middle Name

* Last Name

* Social Security Number

Please list your address of residency for the past 3 years:

Current Address

* Street

* City

* State

* Zip Code

* How Long?

Previous Addresses

* Street

* City

* State

* Zip Code

* How Long?

* Home Phone

* Cell Phone

* E-mail

* Other

* Do you have the legal right to work in the United States?
YesNo

* Date of Birth

* Can you provide proof of age?
YesNo

General Information

* REQUIRED FIELD

* Have you ever worked for MN Express Inc before?
YesNo

Which lane

From (Date)

To (Date)

Rate of Pay

Positon

Reason for leaving

* Are you currently employed?
YesNo

How long since leaving last employment?

Who referred you?

* Is there any reason you might be unable to perform the functions of the job for which you have applied?
YesNo

Explain if you wish:

* Have you ever been convicted of a felony?
YesNo

* Please explain fully. Conviction of a crime is not an automatic bar to employment – all circumstances will be considered.

Employment History

* REQUIRED FIELD

All driver applicants to drive in interstate commerce must provide the following information on all employers/leasors during the preceding 3 years. List a complete mailing address including phone number, street number, city, state, and zip code.

Applicants shall also provide an additional 7 years' information on previous employers/leasors.
A TOTAL OF 10 YEARS HISTORY IS REQUIRED.

NOTE: List employers in reverse order starting with the most recent.

Previous Employers

* Name

* Contact Person

* Address

* City

* State

* Zip Code

* Phone Number

* Fax #

* From (Date)

* To (Date)

* Salary/Wage

* Position Held

* Reason For Leaving

* Subject to FMCSRS?
YesNo
* Were you subject to the dot drug and alcohol testing requirements of 49CFR part 40?
YesNo

Accident Record & Traffic Convictions

* Accident record for the past 3 years or more?
YesNo

Accident

* Date

* Nature of accident
(head-on, rear-end, upset, etc.)

* Fatalities

* Injuries

Traffic convictions & forfeitures for the past 3 years (other than parking violations)

* Traffic convictions & forfeitures for the past 3 years?
YesNo

Traffic conviction or forfeiture

* Location

* Date

* Charge

* Penalty

Education

* Select highest grade completed

* High school

* College

Latest school attended

* Name

* City

Driving Experience

* REQUIRED FIELD

Driver Licenses

* State

* License

* Type

* Expiration Date

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

* Has any license, permit, or privilege ever been suspended or revoked?
YesNo

Drug and alchol information

* Have you ever received a positive test result on any DOT drug collection?
YesNo

* Have you ever received a DOT alcohol test result greater than 0.04?
YesNo

* Have you ever refused to take a DOT alcohol test or DOT drug test?
YesNo

* Have you ever been released from your lease/contract or employment for a drug or alcohol related offense?
YesNo

* Do you have driving experience?
YesNo

Straight truck

* Type of equipment

From (Date)

To (Date)

* Approximate Number of Miles ( Total )

Tractor & semi-trailer

* Type of equipment

From (Date)

To (Date)

* Approximate Number of Miles ( Total )

Tractor –two trailers

* Type of equipment

From (Date)

To (Date)

* Approximate Number of Miles ( Total )

Motorcoach-school bus

* Type of equipment

From (Date)

To (Date)

* Approximate Number of Miles ( Total )

Other

* Type of equipment

From (Date)

To (Date)

* Approximate Number of Miles ( Total )

* List states operated in for last five years

* Show special courses or training that will help you as a driver

* Which safe driving awards do you hold and from whom?

Other Experience and Qualifications

* Show any trucking, transportation or other experience that may help in your work

* List courses and training other than shown elsewhere in this application

* List special equipment or technical materials you can work with (other than those already shown)

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment is intent.)

I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment with MN Express Inc, I understand that false or misleading information given in my application or interview (s) may result in termination/cancellation of lease. I understand also, that I am required to abide by all rules and regulations of the aforementioned company.

Yes, I Agree to these terms?