Company Driver Application                                                        * Required Fields
Personal Information
Driving Experience:         * Dry Van                 Liquid Tanker               Dry Bulk Tanker                      
First/Middle Name:         * Last Name:        *   
Street Address:               *  
City:                               *    State: *      Zip: *     
Birthday:                         * Social Security #:*  
Primary Phone #:            * Email Address:   
Secondary Phone #:  
Professional Driving Information
License #:                      *   State: *     
# Years Driving:             *    # Moving Violations:  *     
Last DOT Physical:        *   Hazmat  End.     * Yes     No
# Preventable Accidents:*     DUI/DWI?:        *
Felony Conviction?         *   Conviction Date?
How did you hear about R.L. Carter Trucking Inc.?
If referred, please name by whom:    
Employment History (Last 3 Employers)
Company:                       *   Phone #:            *  
City:                                *   State: *              Zip:  
Position:                          *  
Employed From:              *   Employed To:     *  
Termination Type:            *  
Reason for Termination:   
Company:    Phone #: 
City:    State:   Zip:  
Position:   
Employed From:    Employed To: 
Termination Type:   
Reason for Termination:   
Company:    Phone #: 
City:    State:   Zip:  
Position:   
Employed From:    Employed To: 
Termination Type:   
Reason for Termination:   

TO BE READ AND AGREED UPON BY APPLICANT

      It is agreed and understood that any misrepresentation of information given shall be considered an act of dishonesty.  It is agreed and understood that the carrier or its agents may investigate the applicant's background to ascertain any and all information of concern to the applicant's record, whether same is of record or not, and applicant releases carrier and persons named herein from all liability for any damages on account of his furnishing such information.  It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.  I agree to furnish such additional information and complete such examinations as may be required to complete my application for qualification file.   I authorize the carrier to obtain from the Registry of Motor Vehicles a copy of my motor vehicle violations record.  It is agreed and understood that this application for qualification under the DOT Regulations in no way obligated the carrier to qualify me, and it is understood that if qualified, I may be on a introductory period during which time I may be released without recourse.  I agree and authorize previous employers to release and forward all information on my alcohol and controlled substance testing.  This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

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