Road Careers

Online Application

Personal Information

First Name

Last Name

Address

City

State

Zip

Date of Birth

Month: Day: Year:

Contact Info

Primary Phone:
Other Phone:
Email:

Driving Information

Are You A Driver School Graduate? Yes No

CDL #: State of Issue:

CDL Class: A B C

Experience with a CDL:

I Will Run (check all that apply) : Local Regional OTR

Endorsements (check all that apply): Hazmat Tanker Double/Triple

Experience Driving:	Tanker	Reefer	Hazmat
(Check all that apply)	HHG	Van	Flatbed
	Auto Carrier	Specialized	Double/Triple

Are You An Owner/Operator Yes No

Have You Held Other CDL Licences in the Past 5 Years? Yes No (If Yes See Below)

Other CDL State: Number:

Have You Ever Been in an At Fault Accident? Yes No

If Yes Select Date

Month: Year: Fatalities: Injuries: Amount of Damage $

Have You Ever Been Convicted of a Felony?

Yes

Date:

Have You Ever Been Convicted of or Have Charges Pending for Driving Under the Influence of Drugs or Alcohol?

Yes

Date:

Have You Ever Been Convicted of or Have Charges Pending for Reckless Driving?

Yes

Date:

Has Your License Ever Been Suspended? Yes No

If Yes Select Date

Suspension Month: Suspension Year:

Do You Have Any Moving Violations Within the Last 3 Years? : Yes No

If Yes Select Date

Occurence #1 -Month Year

Occurence #2 -Month Year

Occurence #3 -Month Year

Employment Information

Please Enter Your Previous Trucking Employers Below In Order of Last Worked

Employer #1

Company Name
Company City		State:

Start Date

End Date

Employer #2

Company Name
Company City		State:

Start Date

End Date

Employer #3

Company Name
Company City		State:

Start Date

End Date

Please Enter Any Additional Info Below:

I authorize Road Careers to forward my information to trucking companies or job recruiters.

Road Careers will not sell or give information to spam lists or any outside unauthorized party.

By clicking Submit I accept this agreement and verify that the above infromation is correct.