USA Cartage Inc. Employment Application
Name:
I am a:	Choose One Driver Owner Operator Student
Trucks Own:	0 1 2 3 4 5 5+
Address:
City:
State:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Home Phone:
Cell Phone:
Email Address:
Date of Birth:	(mm/dd/yy)
Current Driver License Information
Class of License:	Select License Class A B C D E Other
State of Issue:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Endorsements:
Driving Record:
How many tickets have you had in the last 3 years? 0 1 2 3 4 5 6+
How many accidents have you had in the last 3 years? 0 1 2 3 4 5 6+
Explain:
Have you ever had your license suspended or revoked? no yes
Explain:
Have you ever been convicted of DWI or DUI in the last 5 years? no yes
Explain:
Have you ever been convicted of a crime? no yes
Explain:
Have you ever been convicted of a felony? no yes
Explain:
I prefer to run	Southeast East Northeast Midwest Southwest West Northwest Local
Experience	Household Good Exp Van Reefer Auto Carrier Tanker Hazmat Flatbed Specialized Double/Triple
Prefer to pull	Household Good Exp Van Reefer Auto Carrier Tanker Hazmat Flatbed Specialized Double/Triple
Years of Tractor Trailer Driving Experience:
Driver School Graduate :	no yes
I would like to run	Single Team  Husband/Wife
I am interested in a tractor purchase program:	no yes
Employment Information:
Current Employer:
Street:
City:
State:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Phone Number:
Starting Date:	(mm/dd/yy)
Previous Employment Information #1:
Past Employer:
Street:
City:
State:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Phone Number:
Starting Date:	(mm/dd/yy)
Ending Date:
Reason for Leaving:
Previous Employment Information #2:
Past Employer:
Street:
City:
State:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Phone Number:
Starting Date:	(mm/dd/yy)
Ending Date:
Reason for Leaving:
Previous Employment Information #3:
Past Employer:
Street:
City:
State:	Select State AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Phone Number:
Starting Date:	(mm/dd/yy)
Ending Date:
Reason for Leaving:
By submitting this application, I certify that I personally completed this application and that all of the information is correct. I authorize Carrier Companies and their agents that receive this application to perform the background checks they deem necessary in considering my application.