Driver Pre-Application First Name * Middle Last * Suffix Address * City * State / Province * -- Select an option --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOutside the US Zip / Postal Code * Phone Number * Cell Phone Email Address Date of Birth * SSN Current or Most Recent Drivers license Number Which best describes the currrent status of your class A CDL? * -- Select an option --Do Not hold Class A CDLCurrently Hold Class A CDL – No ExperienceCurrently Hold Class A CDL – 0-5 Months ExperienceCurrently Hold Class A CDL – 6 or more Months Experience State you attend(ed) Truck Driving School -- Select an option --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOutside the US How did you hear about Eagle KMC Transportation? -- Select an option --Craigs ListDriving SchoolEmailFacebookTwitterYou TubeNewspaperEagle DriverPostcardEagleTucson.com WebsiteOther WebsiteIndeedDriving SchoolInstagramTV CommercialOther How did you hear about Eagle KMC Transportation? Name of the Truck Driving School you attended Current or Most Recent Employer (If you have more than 3 months experience, you may skip this section and go to Number of Preventable Accidents below) City State / Province -- Select an option --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOutside the US Tractor Trailer Job? Yes No Reason for Leaving? Number of Preventable Accidents in the past 5 years * Number of Moving Violations in the past 5 years * For California applicants: Please do not disclose misdemeanor convictions for marijuana-related offenses that are more than 2 years old, convictions that have been expunged, sealed or statutorily eradicated; misdemeanor convictions for which probation has been successfully completed or discharged and the case has been judicially dismissed; or any referrals to a diversion program. Have you ever been convicted of or are charges currently pending for any of the following: A DUI, DWI, or any other alcohol related offenses? Reckless driving? Have you ever tested positive for drugs or alcohol or refused a drug or alcohol test? Has your license ever been suspended? Yes No If yes, please explain and include dates of license suspension? Applicant Disclaimer: As part of the application process, we will be doing a complete background investigation. This includes obtaining consumer reports about you from HIRERIGHT SOLUTIONS, INC. If we decide not to hire you based on information contained in these reports, we will tell you about your right to obtain a free copy of the report. We will also tell you how to dispute the accuracy of the report. Remember that HIRERIGHT SOLUTIONS, INC. only reports the information to us. They do not make the decision about hiring you. Be advised that the information in your application will be used and that past or present employers will be contacted for purposes of investigation as required by federal DOT regulations. You are hereby notified of your due process rights as specified in 391.23i(1) of the FEDERAL MOTOR CARRIER SAFETY REGULATIONS. 1: The right to review information provided by previous employers. 2: The right to have errors in the information corrected by the previous employer and for that employer to re-send the corrected inforamtion to the prospective employer. 3: 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. Do we have your permission to request your consumer reports? * Yes No
