First name 
       Last name 
  Middle initial 
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
         Country 
      Work Phone 
      Home Phone 
          E-mail 

Social Security Number:

Date of Birth:

-- mm/dd/yy

Date you will be available for orientation:

-- mm/dd/yy

Driver's License Number:

Driver's License State:

Driver's License Expiration Date:

-- mm/dd/yy

CDL?

Yes No

HazMat Endorsement?

Yes No

Number of Tickets in last 3 years?

Number of Accidents in last 3 years?

Describe the accident damage:

Have you ever been arrested for driving while intoxicated?

Yes No

If yes, explain:

Have you ever had your license suspended or revoked?

Yes No

If yes, explain:

Please list your previous driving jobs:

Present/Most Recent Employer:

Dates of Employment: from to

Address:

City: State: Zip:

Telephone:

Type of Trailer: Number of States:

May we contact your present employer? No Yes

1st Previous Employer:

Dates of Employment: from to

Address:

City: State: Zip:

Telephone:

Type of Trailer: Number of States:

2nd Previous Employer:

Dates of Employment: from to

Address:

City: State: Zip:

Telephone:

Type of Trailer: Number of States:

3rd Previous Employer:

Dates of Employment: from to

Address:

City: State: Zip:

Telephone:

Type of Trailer: Number of States:

Please read Disclosure and Release below, and press SUBMIT button at bottom of page if you agree:

Disclosure and Release

I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize any company that receives 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, crimes 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 TL Express, Inc. harmless of all liability for providing this application for my use