Transam Trucking, Truck Drivers, Driving, OTR, Freight

Personal Information
First Name:	......
Middle:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Other Phone:
Pager:	Ext:
Social Security:
Email Address:
How did you hear about us?:

Drivers License and Safety Information
License Number:
Expires:
State Issued:
Birthdate:	19
CDL License Class:	A B C D None
Do You Have A Hazardous Material Endorsement?	Yes No
Have you ever had your license revoked or suspended?	Yes No
Have you had any accidents in the last 3 years?	Yes No
Have you had any tickets in the last 3 years?	Yes No
Have you been convicted of DWI, DUI or BAC in the last 5 years?	Yes No
Have you ever been convicted of a felony?	Yes No
Have you ever been convicted of a crime?	Yes No
If you answered 'Yes' to any of the last 6 questions please give details below.


Driving Preferences
Select what you are most interested in working:
Regional Over-the-road
Solo Team Husband/Wife Team


DRIVING SCHOOL HISTORY
Name of Driving School:
Still in School?	Yes No
If No Please Enter Graduation Date:


Hauling Experience
Type	Trained	Years	Miles
Van	Yes No
Reefer Operation	Yes No
HazMat Hauling	Yes No
Satellite Operation	Yes No


Present Employer
Company Name:
Address:
City:
State:
Zip Code:
Contact Name:
Phone Number:
Employment Dates:	From: To:
Position Title:
Pay Rate:
Reason for Leaving:

Previous Employer 1

Company Name:

Address:

City:

State:

Zip Code:

Contact Name:

Phone Number:

Employment
Dates:

From:
To:

Position Title:

Pay Rate:

Reason for Leaving:

Previous Employer 2

Company Name:

Address:

City:

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Zip Code:

Contact Name:

Phone Number:

Employment
Dates:

From:
To:

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Pay Rate:

Reason for Leaving:

Previous Employer 3

Company Name:

Address:

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Contact Name:

Phone Number:

Employment
Dates:

From:
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Pay Rate:

Reason for Leaving:

COMMENTS

IMPORTANT!!! READ BEFORE APPLYING

FMCSR NOTICE FOR DRIVER APPLICANTS It is expressly acknowledged, understood and agreed that the information provided by the applicant regarding the applicant's employment during the previous three (3) years in accordance with Section 391.21(b)(10) of the Federal Motor Carrier Safety Regulations ("FMCSR") may be used, and the applicant's prior employers may be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraphs (d) and (e) of Section 391.23 of the FMCSR. The applicant has certain due process rights under the FMCSR regarding the information received as a result of these investigations, as described below.

Applicant's Due Process Rights:

The right to review information provided by previous employers
The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to TransAm Trucking, Inc.; and
The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information, must submit a written request to the Safety Compliance Manager of TransAm Trucking, Inc., which may be done at any time, including when applying, or as late as thirty (30) days after being employed or being notified of denial of employment. TransAm Trucking, Inc. will provide this information to the applicant within five (5) business days after receiving the written request. If, however, TransAm Trucking, Inc. has not yet received the requested information from the previous employer(s), then it will provide the information to the applicant within five (5) business days after it receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of TransAm Trucking, Inc. making them available, TransAm Trucking, Inc. will consider the driver to have waived the request to review the records.

[ CLICK HERE ] to view DAC Dicsclosure Form.

I have read and understand these rights as well as having read the DAC Disclosure form *