Apply Today for our towing jobsWe are always looking for new team members! Towing PTO + Benefit Insurance TeamworkApply Now!"*" indicates required fieldsStep 1 of 425%Name* First Middle Last Address* Street Address Address Line 2 City State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long?*Date of Birth* MM slash DD slash YYYY Social Security No.*Hire Date* MM slash DD slash YYYY Telephone Number*Email Address* Previous Three Years ResidencyStreetCityState & Zip Code# YearsStreetCityState & Zip Code# YearsStreetCityState & Zip Code# YearsLicense Information Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.State*License No.*Type*Expiration Date* MM slash DD slash YYYY Driving ExperienceStraight TruckType of Equipment (Van, Tank, Flat, etc.)Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approx No. Of Miles (Total)Tractor and Semi-TrailerType of Equipment (Van, Tank, Flat, etc.)Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approx No. Of Miles (Total)Tractor - Two TrailersType of Equipment (Van, Tank, Flat, etc.)Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approx No. Of Miles (Total)OtherType of Equipment (Van, Tank, Flat, etc.)Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Approx No. Of Miles (Total)Accident Record For Past 3 Years or MoreDate MM slash DD slash YYYY Nature of AccidentNumber FatalitiesNumber InjuriesDate MM slash DD slash YYYY Nature of AccidentNumber FatalitiesNumber InjuriesDate MM slash DD slash YYYY Nature of AccidentNumber FatalitiesNumber InjuriesTraffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)Date Convicted MM slash DD slash YYYY ViolationState of Violation LocationState of Violation LocationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPenaltyDate Convicted MM slash DD slash YYYY ViolationState of Violation LocationState of Violation LocationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPenaltyDate Convicted MM slash DD slash YYYY ViolationState of Violation LocationState of Violation LocationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPenaltyHave you ever been denied a license, permit or privilege to operate a motor vehicle?* Yes NoIf yes, explain*Has any license, permit or privilege ever been suspended or revoked?* Yes NoIf yes, explain*Employment Record Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).Last EmployerPhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position HeldFrom MM slash DD slash YYYY To MM slash DD slash YYYY SalaryReason for LeavingAny Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoSecond Last EmployerPhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position HeldFrom MM slash DD slash YYYY To MM slash DD slash YYYY SalaryReason for LeavingAny Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoThird Last EmployerPhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position HeldFrom MM slash DD slash YYYY To MM slash DD slash YYYY SalaryReason for LeavingAny Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoConsent I authorize you to make sure investigations and inquiries to 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 has been extended.) 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.Consent In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.Consent I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:• Review information provided by current/previous employers; • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information."Front of Driver's License*Max. file size: 256 MB.Back of Driver's LicenseMax. file size: 256 MB.Certifications & Other Documentation Drop files here or Select filesMax. file size: 256 MB.This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.Date* MM slash DD slash YYYY Signature*Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.CAPTCHANameThis field is for validation purposes and should be left unchanged.
