General Information:

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Please check which application type best describes you: (check one box only, then skip down to Personal Information Section). If you check Student Applicant, please tell us the name of the school, the phone number and the date you graduated.)

School Applicant: I do not have a Class A CDL License and have no experience driving a tractor trailer. I wish to apply for CDL Training.

Student Applicant: I have graduated or currently enrolled in a driving school and have obtained or in the process of obtaining a Class A CDL License. Successful applicants will attend a 3 day orientation and be assigned a company driver trainer for a short period. Please provide driver school information including name, phone number, date of graduation or expected date of graduation in the box below.

Short Term Trainee and Refresher Course: I have a Class A CDL License and have less than 1 year of tractor trailer driving experience or have been off the road for awhile and need a refresher course. Successful applicants will go to a 3 day orientation and be assigned a company driver trainer for a short period of time.

Experienced Driver: I have a Class A CDL License and have over 1 year recent tractor trailer driving experience. Successful applicants will go to a 3 day orientation and be assigned a truck.

Lease Operator or Owner Operator: I want to lease a truck or I already own my truck and want to haul freight for a company.

Personal Information:

First Name: (*IMPORTANT-write exactly as it appears on your current Drivers License)

Middle Initial: Last Name: (If a Jr., Sr., II, III, etc., please include)

Street Address:

City: State: Zip:

Social Security #: - -

Home Phone #: ( ) - - * Cell Phone #: ( ) - -

E-mail: Date of Birth: (Format: yy/yy/yyyy)

Best time to reach you: A.M. P.M.

Birth Place: City: State:

Date you are available for employment: (Format: yy/yy/yyyy)

Drivers License Information:

Drivers License #: State: Exp. Date: (Mo./Yr. Only)

Do you have a CDL License: Yes No If yes, do you have Haz-Mat endorsement: Yes No

Have you had any other license in any other state in the last (5) five years? Yes No

If yes, what State: License #:

Have you ever had your drivers license, permit, or driving privileges suspended or revoked? Yes No

If yes, please explain below. If No, skip to the next question.

Number of traffic violations in the last (5) five years: None 1 2 3 4 5 6 7 8 9 10

Please explain details of violations, such as date, type, etc.

Number of Accidents in the last (5) five years: None 1 2 3 4 5 6 7 8 9 10

Please explain nature of accident, dollar amount of damage, and if you were at fault:

Have you ever been convicted for DUI, DWI, driving while intoxicated under the influence of alcohol or drugs:

Yes No * If yes, list dates and circumstances of each conviction below:

Have you ever been convicted of a crime: Yes No (Felony or misdemeanor)

If yes, list whether a misdemeanor or felony along with when and why you were convicted:

Employment History:

The Department of Transportation requires the last (3) three years of employment if you are inexperienced, or the last 10 years if you are an experienced driver. If you were a student, your transcript or proof of attendance is OK! If you were in the Military you'll need your DD214 form and possibly the contact name and phone number of your Unit Commander. List your most recent employment first and go backwards in chronological order. If you've had more than (2) two employers in the past (3) three years you can list additional employer information in the additional space provided below. Consider school, unemployment, military, etc., as employment and list accordingly. Gaps of employment can be explain in the additional space provided below this section. Remember to start with your current or most recent employer and go backwards in chronological order. If you are currently unemployed, write Unemployed".

Name of Most Recent or Current Employer:

Start Date: (Format: yy/yy/yyyy) End Date: (Format: yy/yy/yyyy)

Address: City: State: Zip Code:

Phone #: ( ) - - * Ext. * Contact:

Your Job Title:

Reason for Leaving:

Name of Previous Employer:

Start Date: (Format: yy/yy/yyyy) End Date: (Format: yy/yy/yyyy)

Address: City: State: Zip Code:

Phone #: ( ) - - * Ext. * Contact:

Your Job Title:

Reason for Leaving:

IMPORTANT! You must list at least a minimum of (3) three years of work history which can include unemployment, military and school. If you need additional space to list more employers use the space below and type in the information. Use the space below to explain any gaps of employment as well as additional employers.

Personal References:

Name: Relationship: Phone #: ( ) - -

Name: Relationship: Phone #: ( ) - -

Name: Relationship: Phone #: ( ) - -

You must meet the following requirements:

1. Be 21 years of age or older.

2. Be able to read and speak the English language in accordance with the Federal Motor Carrier Safety regulations.

3. Have a Commercial Drivers License and any appropriate endorsements and state requirements to be carried in the truck cab while driver is in service.

4. Be able to qualify physicially and obtain a Medical Examiners Certificate under the requirements of the Federal Motor Carrier Safety Regulations.

5. Be able to sit for extended periods of time in a tractor truck.

6. Be able to drive for as many as 10 hours a day, while transporting hazardous and not hazardous materials in various weather conditions.

7. Be able to make correct and accurate decisions when dealing with customers and the motoring public.

8. Be able to walk, bend, reach, push, pull, stoop, climb, grasp and life in order to do the following task:

a. To perform vehicle inspections required under the Federal Motor Carriers Safety Regulations.

b. To handle heavy equipment as necessary to ensure safety during both hooking and dropping process of tractor trailer combinations.

c. To lift 75 pounds to the waist (repetitively) and 42 pounds over the head (repetitively) when loading and unloading freight or installing chains.

9. Be able to read a map and complete a trip plan.

10. Be able to set and complete individual daily goals.

11. Be able to report for dispatch at the time specified and to maintain contact with dispatch offices as required.

12. Be able to complete driver daily logs and all necessary trip reports, fuel reports, damage reports, and other paperwork required by the company to be turned in as instructed.

13. Be able to familiarize yourself with and comply with proper method of loading and unloading for the various cargos to be transported.

14. Be able to follow company guidelines in regard to acceptable conduct when dealing with customers, fellow employees and the motoring public.

I have read and understand the job description and certify that I am able to meet the requirements for this position. I further certify that I have not used any illegal drugs in the past 5 months. I am not on parole or probation, which would limit my ability to travel unrestricted to all points in the U.S. and Canada. I currently only have one valid license in my possession and I certify that my current drivers license is not suspended.

I certify that I personally completed this application and that all the information is true and correct. I hereby request and authorize Trucking Careers of America LLC (TCA) and its agents or contractors that receive this application to investigate my background for employment purposes, which may include, but not limited to any information relating to my character, general reputation, personal characteristic, mode of living, criminal history, driving record, credit history, past work experience and employment. Any information gathered from any individual, organization, entity, agency, or any other source may be used in consideration for employment and or grounds for dismissal. I have completed this application of my own free will and hold TCA, its agents and contractors harmless of all liability concerning the use of this application. This application is used solely for consideration of the mentioned CDL Training and Job Placement Program described.

Signature Required: Type your name above

(click the submit button only once to submit)

If you experience any problems with this Document, please print and mail or fax to (678) 535-7025

Phone Applications Accepted - Call (866) 634-1365 Toll-Free

- If submitting online call (866) 634-1365 within 24 hours and check the status of your application -
Georgia Local Residents Call (770) 877-5977

Thank you for your Application!

Trucking Careers of America LLC * 210 Station Way, Adairsville, GA 30103

Tel: (866) 634-1365 * Fax: (678) 535-7025 * Georgia Local Residents: (770) 877-5977

www.truckingcareersofamerica.com
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