Driver Application
Personal Information
Contact Information
Full Name:
Address 1:
Address 2:
City:
State: Zip:
Day Phone: Cell Phone:
Night Phone:
Email: Best time to call:
SSN:
Date of Birth #:
Driver License Information
Do you have a Driver License?  Yes  No DL Number:
Issue State: Expiration Date:
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
 I am currently part of a team   **If so, enter your partner's name and contact information below.
Date Available:
Check all that apply:
I need training I am a Driving School Graduate
School name: When:
Experience and Preference
Total OTR years:
Trailer Type Experience and Preference
TRAILER TYPE EXPERIENCE YEARS PREFERS
Flatbed
Van
Employment History
I am currently employed. Number of jobs in last 3 years
Current Employer
Employer name :
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven Length of truck  
Previous Employer#1
Employer name :
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven Length of truck  
Previous Employer#2
Employer name :
Address Phone
City State Zip
Start date
End date
Position held
You may contact this employer
Reason left
Vehicle driven
Previous Employer#3
Employer name :
Address Phone
City State Zip
Start date
End date
Position held
Supervisor You may contact this employer
Reason left
Vehicle driven Length of truck  
Additional Employment Information
Owner Operator
(Not an Owner Operator? Please skip this section)
Tractor
Do you own your tractor?   Yes  No Manufacturer
Year Model
Fifth wheel height
Wheel base
Driving History
Accidents
Number of accidents involved
Number of preventable accidents
Number of roll-over accidents
Tickets
Number of tickets received
Number of preventable tickets
Number of reckless tickets
Addition Driving History Information
Criminal Record
If so, when...
Have you ever been convicted of a felony? 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 convicted of a misdemeanor? Yes  No
Have you ever been convicted of a crime or have any charges pending? 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 tested positive or refused a test for drugs or alcohol? Yes  No
Have you ever abandoned your equipment? Yes  No
Comments
This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I hereby request and authorize Total Transportation of Mississippi LLC and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from DAC Services. DAC is a consumer reporting agency. Any decision they make not to hire you based on information contained in your consumer report will be their decision alone. DAC does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies themselves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report. Your consent for these companies to obtain the report from DAC is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.
I have read the above release and I give permission to obtain consumer reports about me from DAC.
Yes  No

Would you like to receive emails from this carrier regarding future positions?
Yes  No