Application Form Test

    Please Fill Out All Fields Completely

    Driver's Application

    *-Required Fields

    *Date:

    *First Name:

    *Middle Name:

    *Last Name:

    *Email Address:

    *Date of Birth:

    *Address:

    *City:

    *State:

    *Zip:

    *Phone Number:

    *Have you ever worked for Ee-Jay?:

    If Yes, please indicate when:

    Position Applied for:

    *How did you hear about us?:

    *Do you possess a Passport or Passport Card?:

    *Can you travel into Canada?:

    *Do you have any physical restrictions that would not allow you to lift 50 lb. hoses, climb vertical ladders or work at heights 12’ to 15’?:

    *How many verifiable years of Class A Driving experience do you have?:

    *When was the last time you drove a Class A Tractor Trailer?:

    *Have you ever been convicted for a DWI or DUI?:

    *If yes, when?:

    Driver's License Information

    *State:

    *Endorsements:

    *Date Issued:

    *Expirations Date:

    *Any Restrictions:

    Work History

    Employer #1

    From Month/Year to Month/Year:

    Company:

    Address:

    City:

    State:

    Zip:

    Phone Number:

    Supervisor:

    Full Time or Part Time

    Type of Trailer Pulled:

    Type of Equipment Driven:

    Number of Accidents:

    Number of States driven in:

    Position:

    Pay:

    Hours/Miles per Week:

    Reason for Leaving:

    May we contact this employer?:

    Employer #2

    From Month/Year to Month/Year:

    Company:

    Address:

    City:

    State:

    Zip:

    Phone Number:

    Supervisor:

    Full Time or Part Time

    Type of Trailer Pulled:

    Type of Equipment Driven:

    Number of Accidents:

    Number of States driven in:

    Position:

    Pay:

    Hours/Miles per Week:

    Reason for Leaving:

    May we contact this employer?:

    Employer #3

    From Month/Year to Month/Year:

    Company:

    Address:

    City:

    State:

    Zip:

    Phone Number:

    Supervisor:

    Full Time or Part Time

    Type of Trailer Pulled:

    Type of Equipment Driven:

    Number of Accidents:

    Number of States driven in:

    Position:

    Pay:

    Hours/Miles per Week:

    Reason for Leaving:

    May we contact this employer?:

    Traffic Convictions (During Last 3 Years)

    Conviction #1

    Specify State:

    Date:

    Penalty:

    Charge (Describe):

    Conviction #2

    Specify State:

    Date:

    Penalty:

    Charge (Describe):

    Conviction #3

    Specify State:

    Date:

    Penalty:

    Charge (Describe):

    Driving Accidents (During Last 3 Years)

    Most Recent

    Date:

    Vehicle Driven:

    Property Damage:

    Fatality/Injury:

    Description:

    Next Previous

    Date:

    Vehicle Driven:

    Property Damage:

    Fatality/Injury:

    Description:

    Next Previous

    Date:

    Vehicle Driven:

    Property Damage:

    Fatality/Injury:

    Description:

    Felony Convictions

    Have you ever been convicted of a felony?:

    If Yes, please explain:

    Please Enter the Code Below:

    captcha

    By submitting this application, I authorize and release from liability Ee-Jay Motor Transports, Inc. to investigate all statements made on my application.