All Fields Are Required Information If you can not provide all information, please explain in "Additional Comments" area provided. Contact Information Full Name SS Number DOB (mm/dd/yyyy) Address City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Best Time To Be ReachedTelephone E-Mail Address Driving Experience Occupation Recent ExperienceEndorsements Owner Operator Van Haz-Mat Professional Driver Flatbed None Recent Graduate Reefer Student In Need of Training Other Class A CDL # State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Expiration Date (mm/dd/yyyy) OTR Driving Experience less than 3 months 3-5 months 6-8 months 9-11 months 12-17 months 18-23 months 2 years 3 years 4 years 5-10 years more than 10 years Local Driving Experience less than 3 months 3-5 months 6-8 months 9-11 months 12-17 months 18-23 months 2 years 3 years 4 years 5-10 years more than 10 years Verifiable OTR Miles in Past 6 Months Number of Accidents: Number of Moving Violations: Last Year Last Year Last Three Years Last Three Years Last Five Years Last Five Years Has Your License Ever Been Revoked or Suspended? Yes No Have You Ever Been Cited for DUI or DWI? Yes No If yes, how long ago (years)? Have You Ever Been Convicted of a Felony? Yes No Owner Operators Manufacturer Year/Model Type Engine Size Max RPM Electronically Controlled?Yes No Ratio Tractor Weight Wheelbase 5th Wheel Height Do You Own Your Own Trailer? Yes No If So, What Type? Present Employer ( Please provide employment history for past 10 years) Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Most Recent Past Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Next previous Employer Company Address City StateAL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Telephone Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Supervisor Type of Trailer Number of States Reason for Leaving Wage Expectations What are your wage expectations? Additional Information Any additional information or comments Can Former Employers be contacted? Yes No Can You Begin Working Immediately? Yes No If Not, State When (mm/dd/yyyy) By submitting this application electronically, I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Dauninge Transport 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. In connection with my application for employment, I understand that consumer reports which may contain public record information may be requested. I understand that the completion of this form does not assure me of a position with any company or obligate the company in any way. I have completed this application of my own free will and hold Dauninge Transport harmless of all liability for providing this application for my use.Applications will remain on file for one year. We will only contact prospective employees.Thank You for Your Interest in Working with Us Or you can fax it to: 479-787-5463Or mail to: Dauninge Transport 12557 Dickson Rd Hiwasse, AR 72739
By submitting this application electronically, I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Dauninge Transport 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. In connection with my application for employment, I understand that consumer reports which may contain public record information may be requested. I understand that the completion of this form does not assure me of a position with any company or obligate the company in any way. I have completed this application of my own free will and hold Dauninge Transport harmless of all liability for providing this application for my use.Applications will remain on file for one year. We will only contact prospective employees.