EmailMe Form - Truckers Needed Secure Application (Denise)

Truckers Needed Corp Secure Site: Your Data will never be shared or sold ever nor will you get 100 phone calls from recruiters all over the country. One Application, one call, dozens of job opportunities.

CONTACT INFORMATION
Name *
First Last Suffix
Do you have a Mobile Phone you can receive text to? *
Mobile Phone *
### - ### - ####
(Cell phone you can text to here)
Home Phone (Optional)
### - ### - ####
The more ways we have to contact you the better.
Email
If Having problems inputting your email leave this block blank
Confirm Email *
Address *
City *
STATE *
Zip *
Social Security Number (No dashes -) *
Example 123456789 (this is "Optional" and not required to complete this form. You can put the example # in if you prefer as there has to be a 9 digit number in this block, however this could delay the hiring process)
Date of Birth *
MM / DD / YYYY
Emergency Contact (Name, PHONE, Relationship, address, City State, Zip) *
Reference (Name, PHONE, Relationship, address, City State, Zip) *
Please do not use your Emergency Contact as a reference.
Are you Currently Unemployed? *
Date you became Unemployed
MM / DD / YYYY
Date you would like to start if approved *
MM / DD / YYYY
LICENSE INFORMATION
CDL/DL # *
CDL/DL Class *
STATE ISSUED *
CDL/DL EXPIRATION DATE *
MM / DD / YYYY
DOT Medical Expiration Date
(current put date, if expired leave blank)
MM / DD / YYYY
RELOCATING? IF YES Select State..
Approx what Date are you relocating
MM / DD / YYYY
License Ever been Revoked or Suspended? *
If DL revoked or suspended reason why! *
(child support, defective equipment, dui, non-payment of ticket)
Date Suspended *
MM / DD / YYYY
DRIVING INFORMATION
What Type of Driving Job are you looking for? *
2nd Option for What Type of Driving Job are you looking for? *
What is your 2nd choice if first choice is not available.

OTR may be your only option depending on your situation, so try to be realistic.
Willing to drive Teams *
Do You Have a Team Mate? *
Team Mates Name
Are you an OWNER OPERATOR *
Truck "YEAR", "MAKE", & "MODEL"
Total Class A Tractor Trailer Experience *
Local and OTR Tractor Trailer experience.
Do you have "ANY" Over The Road Tractor Trailer time in the last 3 years? *
OVER THE ROAD EXPERIENCE--3 to 5 states in a Sleeper, not a Day Cab
Tractor Trailer experience means Conventional Tractor not straight truck, dump truck etc...hauling at least a 40-45 trailer or longer.
(Truck School experience does not count as TT time, so do not use your time in truck school towards your tractor trailer time )
TT OTR Experience last 12 Months *
OVER THE ROAD EXPERIENCE--3 to 5 states in a Sleeper, not a Day Cab
TT OTR Experience last 3 Years *
OVER THE ROAD EXPERIENCE--3 to 5 states in a Sleeper, not a Day Cab
Do you have "ANY" "LOCAL" Tractor Trailer time in the last 3 years? *
Any driving Tractor Trailers, not straight trucks, Class B trucks etc, but "NOT" OVER THE ROAD EXPERIENCE, Day Cabs or sleeper but not OTR.
LOCAL TT Experience last 12 Months *
OVER THE ROAD EXPERIENCE--3 to 5 states in a Sleeper, not a Day Cab
LOCAL TT Experience last 3 Years *
OVER THE ROAD EXPERIENCE--3 to 5 states in a Sleeper, not a Day Cab
Driver Type *
What endorsements do you have? *
Hazardous
Doubles/Triples
Tanker
TWIC
Passenger
NONE OF THE ABOVE
Other
Select "ALL ITEMS" that Apply to you!
Willing to get hazmat if you don't have it? *
Did you to go Truck School within the last 3 years? *
If Truck School in last 3 years, Name of School and location
Date Graduated Truck School
(If Applicable if not leave blank)
MM / DD / YYYY
Former or Current Military
Were you Terminated/Fired from your last Job? *
If Terminated Please explain why you were let go. We need the actual reason. *
Don't just say "I quit" or was "let go" we need the specific reason why you are no longer at that job.
BACKGROUND/MVR
1: Have you been convicted of a DWI, DUI, or BAC within the last 5 years? *
MAKE SURE YOU PUT DATE & STATE in the Comments Block below if Applicable
IF DUI/DUI's NEED DATE and STATE HERE: *
(If Applicable, skip if it doesn't apply) IF MORE THAN ONE DUI LIST ALL OF THEM HERE ALONG WITH THE DATES THEY HAPPENED!
2: Have you ever failed a DOT or Pre-employment drug or alcohol test in the last 5 years? *
MAKE SURE YOU PUT DATE & STATE in the Comments Block below if Applicable
FAILED OR REFUSED DRUG TEST NEED DATE and STATE HERE: *

Refused is the same as Failed and you must list that here along with the Date and State.
3: Have you had any Reckless/Careless Driving tickets in the past 5 years (POV or CMV)?* *
MAKE SURE YOU PUT DATE & STATE in the Comments Block below if Applicable
RECKLESS OR CARELESS TICKET NEED DATE and STATE HERE: *

Crucial you list whether it as RECKLESS or CARELESS and the DATE and STATE.
4: Have you had any OVER 15 MPH Speeding Tickets, Lane Change Violation, Following Too Close, Using a Cell Phone tickets in the last 3 years (POV or CMV)? *
MAKE SURE YOU PUT THE EXACT ITEM OR ITEMS + the DATE & STATE in the Comments Block below (If Applicable)
ALL MAJOR TICKETS(S) "TYPE", DATE AND STATE *
DID YOU LIST ALL MAJOR TICKETS ALONG WITH THE DATE AND STATE? It is crucial that we know this data so we can help you get hired.
5: Have you had any DOT Reportable Accidents/Incidents (Preventable) in the last 5 years (POV or CMV)?*

Please put the date/dates and explanation in the remarks below *
Please put the date/dates the state and the TYPE of accident/accidents if multiple in the Comments Block below (If Applicable)
ACCIDENTS/INCIDENTS (LIST ALL) TYPE OF ACCIDENT/INCIDENT, DATE, STATE & DETAILS OF ACCIDENT *
Make sure you list ALL accidents and incidents and whether they were PREVENTABLE or NOT. Incidents also count and must be listed here.
6: Have you had any Felonies or Misdemeanors iEVER* (Even 20 years or more ago they need to be listed if they are on your record)

Please put DATE/DATES, nature of offense in the remarks below if applicable *
Please put the nature of the Felony/Misd, the state and the date in the Comments Block below (If Applicable)
FELONY - (All of them, even if 20 years old) TYPE & DATE, STATE AND RESULT (Jail, fine, Probation etc) *
List All felonies here: Type, Date, State and Result
(If Applicable, skip if it doesn't apply)
MISDEAMONOR - (All of them even if 20 years old) TYPE & DATE, STATE AND RESULT (Jail, fine, Probation etc) *
List All misd here: Type, Date, State and Result
(If Applicable, skip if it doesn't apply)
7: Moving Violations ( last 3 years) Any additional tickets not listed in Major Tickets item 4 above)

Please put the date/dates and explanation in the remarks below *
Please put the date/dates and explanation in the remarks below (If Applicable)
MOVING VIOLATIONS: (all) List the type of ticket (s) here, DATE & STATE of Tickets (s) *
WE HAVE TO KNOW THE COMPLETE LIST OF TICKETS AND THE TYPE, WHETHER IT WAS IN A POV OR CMV AND "WHEN" THE DATE IS CRUCIAL TO HELPING YOU GET HIRED.
8: Number of Jobs (last 12 Months) *
This information is REQUIRED**
Number of Jobs (last 3 years) *
This information is REQUIRED**
Additional Comments/Remarks

Please clarify any thing above that you want to explain in detail so we can help you get hried.
FINAL STEPS
Resume (Optional)
DO YOU HAVE A CURRENT RESUME WITH AT LEAST 3 YEARS OF EMPLOYMENT ON IT, INCLUDING THE CITY, STATE, START DATES AND END DATES FOR THE COMPANIES YOU WORKED FOR?

IF YOU HAVE A CURRENT RESUME "ATTACH" IT HERE.

IF YOU DON'T HAVE A RESUME WHEN YOU HIT SUBMIT BELOW YOU WILL BE ABLE TO COMPLETE EMPLOYMENT AT THE SITE THAT POPS UP.

Click on the ADD FILE link here. You can add more than one document.

Add File
How did you find us? *
I AGREE *
I AGREE TO THE TERMS AND CONDITIONS LISTED AT the PSP Notice website below

CLICK HERE FOR PSP NOTICE
IF YOU CAN'T SUBMIT THIS FORM FOR ANY REASON, MAKE SURE YOU CLICK ON "SAVE AND RESUME" button below AND YOU WILL "NOT" LOSE YOUR INFORMATION.
Signature
Clear
Please sign your name using your Mouse, your Finger if on a mobile Device or a stylus.

IF YOU CAN'T SIGN HERE SIGN THE DIGITAL APPLICATION BELOW AND THEN SUBMIT FORM
DIGITAL SIGNATURE **

(ONLY if not able to sign above)
NOT REQUIRED unless you were not able to sign above.

If unable to sign above Please type your full legal Name in this Block

iF YOU CANNOT SUBMIT THE FORM WHEN CLICK BELOW, Always select "SAVE AND RESUME" below first so you don't lose any information before contacting us.

ANY ISSUES SUBMITTNG THIS FORM PLEASE CONTACT US: TO CONTACT US CLICK "HERE"
You will automatically be redirected to the Employment form after you click Submit.
If you have "NOT" attached a Resume above with employment information on it, please complete the "EMPLOYMENT FORM" that WILL POP UP after you click SUBMIT.

IF YOU ARE UNABLE TO SUBMIT THIS FORM FOR ANY REASON PLEASE MAKE SURE YOU CLICK ON "SAVE AND RESUME" SO YOU DON'T LOSE ANY INFORMATION.