EAGLE EXPRESS INC.

5601 Belleville Road, Canton, MI 48188
Phone 800-933-0215 x1061 Fax 734-397-1461

DRIVER
APPLICATION FOR EMPLOYMENT

(Please answer all questions)

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

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Please select your state

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Please input a valid social security number,

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Do you have the legal right to work in the United States?
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Can you provide proof of age?
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ADDRESSES FOR PAST THREE YEARS

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PREVIOUSLY EMPLOYED WITH EAGLE EXPRESS INC.?

Have you ever worked for this company before?
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MUST SUPPLY 10 YEARS OF EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years of information on those employers for whom the applicant operated such vehicle.

(Note: List employers in reverse order starting with the most recent.)

EMPLOYER 1

Please list current or most recent employer.

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EMPLOYER 2

Please list 2nd most recent employer.

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EMPLOYER 3

Please list 3rd most recent employer.

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EMPLOYER 4

Please list 4th most recent employer.

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EMPLOYER 5

Please list 5th most recent employer.

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EMPLOYER 6

Please list 6th most recent employer.

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EXPERIENCE AND QUALIFICATIONS

* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

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Do you have a hazardous endorsement?
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Have you ever been...

Denied a license?
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Suspended/Revoked?
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Convicted of a felony?
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Have you ever been involved in an accident either in a private vehicle or CDL vehicle in the last 3 years?
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Have you ever had blackouts, blood pressure problems, diabetes symptoms, vision problems, hearing problems?
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Are you a caregiver for any person that would require regular time off to handle?
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Have you ever been off work longer than one week for medical problems of any kind?
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Have you ever been hospitalized for any reason?
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Have you ever been arrested for OUIL, OUID, ticketed for Reckless or Careless driving?
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Have you ever received a warning from your state’s license division concerning your driving?
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Are you now or have you ever been a party to a lawsuit from a traffic accident you were involved in?
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Have you ever changed your drivers license/CDL from one state to another for any reason?
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Are you aware that the Federal Government does background checks on CDLs?
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Have you ever damaged a trailer or other objects while under load/dispatch OR while bobtailing?
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Have you ever been charged for a hit and run accident or damage claim?
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Have you ever been citied for an at fault accident?
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Have you ever paid damages for a claim caused by yourself?
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Have you ever been injured or injured anyone in a crash?
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Have you ever been shutdown at a DOT stop/inspection?
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Are you aware that all inspection sheets must be directly turned in to your company?
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Have you failed a DOT Alcohol/Drug screen in the last 3 years?
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TO BE READ AND SIGNED BY APPLICANT

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.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) my result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

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Please use your mouse or your finger to sign this application

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