Application Please enable JavaScript in your browser to complete this form.Complete Application - Step 1 of 6Name *FirstMiddleLastOther Last Names Used, Maiden Name, or Previous Alias's & Nicknames:Date of Birth *Social Security Number *Email *How did you hear about us?Rate of Pay Expected:Current Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrevious Addresses (only for the past 3 years)Second YearThird YearPassport/Passport Card & Transportation Worker Identification Credential (TWIC) InformationThe following is NOT REQUIRED for employment at - but can be helpful. So if you have any of this information please fill out truthfully and fully.I am able & willing to travel to Canada: *YesNoI posses a Passport or Passport Card *YesNoCountryPassport NoExpirationI posses a TWIC card *YesNoTWIC ExpirationNextCommercial Motor Vehicle (CMV) & Work Related HistoryAccording to FMCSR Sec 391.21(b) every applicant need to describe the nature and extent of their experience in the operation of motor vehicles. The next two pages of this application satisfies that request.Current & Past Driver's License Information Section 383.21 of the FMCSRs states, "No person who operates a commercial motor vehicle shall at anytime have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.StateN/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense #ExpirationCheckboxesCheck this box if you have never had a license from a different state.EndorsementsH, HazardousN, TankP, PassengersS, School BusT, Doubles & TripletsX, Hazardous & TankIf you checked H or X, please put your expiration dateRestrictionsIf you have ever had driver's licenses in different states please mark them here:StateN/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense #State 2N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense # 2Check this box if you have experience driving in at all 48 states.Check this box if you have experience driving in Canada.Please mark all states in which you have CMV driving experience. SKIP this if you checked that you have driving experience in all 48 statesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingRestricted Areas RequestIf you have objections to driving in certain areas please make them known now. (Please note, that pay may be decreased depending on areas a driver is unwilling to drive)1. Area1. Reason That You Are Unable to Drive in This Location2. Area2. Reason That You Are Unable to Drive in This LocationNextCommercial Motor Vehicle (CMV) & Work Related History (copy)According to FMCSR Sec 391.21(b) every applicant need to describe the nature and extent of their experience in the operation of motor vehicles. The next two pages of this application satisfies that request.Straight TruckYearsMonthsTotal MilesTractor with 1 TrailerYearsMonthsTotal MilesTractor with 2 or 3 TrailersYearsMonthsTotal MilesMotor coach or School BusYearsMonthsTotal MilesFlatbed TrailersYearsMonthsTotal MilesDry Van TrailersYearsMonthsTotal MilesRefrigerated TrailersYearsMonthsTotal MilesTank TrailersYearsMonthsTotal MilesList all accidents in the past 3 years; start with the most recent and work backwards.Initial if no accidents in the past 3 yearsDateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingNumber of FatalitiesNumber of InjuriesAdd MoreDate (copy)DropdownAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingNumber of Fatalities (copy)Number of Injuries (copy)Check YES or NOPlease note that checking yes to any of the following does not mean that you are ineligible for employment.Have you ever been arrested, convicted, or received a suspended sentence for a felony charge? *YesNoHave you ever been denied a license, permit, or privilege to operate a motor vehicle? *YesNoHas any license, permit, or privilege to operate a motor vehicle ever been suspended or revoked? *YesNoHave you ever been convicted of a DUI, DWI, reckless driving, or leaving the scene of an accident? *YesNoHave you ever been convicted of drug possession/distribution or any other drug violations? *YesNoHave you ever been or are you now on parole or probation? *YesNoHave you ever been in violation of the FMCSA or DOT drug & testing regulations? *YesNoIf you answered YES to any of the above questions, please explain in detailNextPrevious Employment Record & Information Release (Part 1 of 2)All applicants must provide the following information All employers for the last 3 years (including periods of unemployment) Failure to complete this fully may result in denial of employment All employers for which you drove a commercial vehicle in the last 10 years All required information for an employer has an asterisk (*)Are you currently employed? *YesNoIf no, when was your last date of employment:For the last 3 years please declare any gaps in employment or unemployment equaling one month or longer (mm/yy):FromToReasonFromToReasonFromToReasonFromToReasonDOT & FMCSA Information Release From All Previous EmployersWith my signature below I allow Transcar Express, LLC, to inquire into my entire employment history with all previous employers listed below (and those that are revealed because of background screening), to gather employment related information that is including, but not limited to, all records that they may have on file, but especially all DOT regulated drug and alcohol testing records. I understand that this release is in accordance with CFR part 40.25 and Part 391.23 of the Federal Motor Carrier Safety Regulations (FMSCRs). I also agree to waving any rights that I may have to see the response of my previous employers.Drivers NameDriver Social Security No.DatePlease start with your most recent employer and work backwards:Company NameAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneStart DateEnd DateWas your position at this company subject to the FMCSRs?YesNoWas your position subject to 49 CFR 40 drug & alcohol testing regulations?YesNoReason for leavingVoluntaryTerminatedLaid-OffPlease ExplainPosition HeldWage/Salary/Per Mile/%May we contact?YesNoAdd another employerCompany Name (copy)Address (copy)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone (copy)Start Date (copy)End Date (copy)Was your position at this company subject to the FMCSRs? (copy)YesNoWas your position subject to 49 CFR 40 drug & alcohol testing regulations? (copy)YesNoPlease Explain (copy)Position Held (copy)Wage/Salary/Per Mile/% (copy)May we contact? (copy)YesNo (copy)Add another employerNextApplication and Background Check AgreementPlacing my initials next to each paragraph certifies that I understand and agree with each paragraph. If I have any further questions it is upon myself to ask, and seek out the answers. I should not sign and initial unless I am in complete agreement with everything below.I authorize Transcar Express, LLC to make investigations and inquiries into my personal, employment, financial, medical history, and other related matters as may become necessary in arriving at an employment decision (generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release (including those not listed in the application) employers, schools, health care providers, and all 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 any false or misleading information given on my application or interviews may result in termination. I also understand that I am required to abide by all rules and regulations set forth in company policies. *Check to authorizeI authorize Transcar Express, LLC to send me to an external vendor to collect a pre-employment drug test in accordance with 49 CFR part 40 and in the FMCSRs part 382. *Check to authorizeTranscar Express LLC (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period, as allowed by law. *Check to authorizeHireRight, Inc. ("HireRight"), or another consumer reporting agency, will prepare or assemble the background reports for the Company. HireRight is located and can be contacted by mail at 3349 Michelson Dr. Suite 150, Irvine, CA 92612, and HireRight can be contacted by phone at (800) 400-2761. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx. *Check to authorizeThe background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker's compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. *Check to authorizeThis information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated *Check to authorizeYou may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company. *Check to authorizeA summary of your rights under the Fair Credit Reporting Act, as well as certain state-specific notices, are also being provided to you. *Check to authorizeI have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as HireRight, Inc. ("HireRight"), and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period from HireRight and/or other consumer reporting agencies. *Check to authorizeI understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. *Check to authorizeI hereby authorize all of the following, without limitation, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local agencies, learning institutions (including public and private schools, colleges and universities), testing agencies, information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my employment and earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses. *Check to authorizeBy printing my name below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company. *Check to authorizeIn addition to completely understanding & agreeing with the above statements: My signature below certifies that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.Name *FirstLastToday's Date *Date available to start *NextFMCSA Pre-Employment Screening Program (PSP) Check AgreementIMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online ServiceIn connection with your application for employment with Transcar Express, LLC (“Prospective Employer”), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication. Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization.AUTHORIZATIONIf you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: authorize Transcar Express, LLC (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.Name *FirstLastToday's Date *Submit