Western Express Application

Please complete your application, then click the submit button at the bottom. Required U.S. Citizenship For All Applicants

*Denotes a required field for application to be submitted.

Personal And Contact Information

* First and Last Name
* Date of Birth
* SSN 123-45-6789
* Day Phone Number 123-45-7890
* Evening Phone Number 123-45-7890
* Best Time For Calling Back
* Street Address
* City
* State
* Zip Code
E-mail

CDL Info.

License #
State
Expiration Date
Class
Class A
Class B
Class C
Endorsements
Hazmat
Double/Triple
Tanker

Driving and Experience Information

Driver School Graduate?
Yes No
*I am currently:
Owner Operator
Company Driver
Student
# of trucks O/O owns
*Years of Tractor Trailer Driving Experience
Freight Hauling Experiences (check all that apply)
HHG
Tanker
Flatbed
Van
Reefer
Specialized
Auto Carrier
Hazmat
Double/Triple
Regions I Am Willing to Run (check all that apply)
Southeast
Northeast
Midwest
Northwest
Southwest
Local
Freight preferred (check all that apply)
HHG
Tanker
Flatbed
Van
Reefer
Specialized
Auto Carrier
Hazmat
Double/Triple
Traffic Violations (Within last three years, other than parking)
Number of Accidents (Within past three years)
Team Preference
Single
Team
Husband/Wife
Are you interested in a Lease/Purchase Plan?
Yes or No

Employer Information

Current Employer
Employer Address (Street / City / State / Zip)
Starting Date (mm-dd-yyy)
Employer Phone Number 123-456-789
Reason For Leaving
Are you currently driving for this employer?
Yes No
#1 Employer Name
Employer Address Street / City / State / Zip
Starting Date (mm-dd-yyy)
Employer Phone Number 123-456-7890
Ending Date (mm-dd-yyy)
Position Held
Driver
Mechanic
Recruiter
Other
Reason For Leaving
#2 Employer Name
Employer AddressStreet / City / State / Zip
Starting Date (mm-dd-yyy)
Employer Phone Number 123-456-7890
Ending Date (mm-dd-yyy)
Position Held
Driver
Mechanic
Recruiter
Other
Reason For Leaving
#3 Employer Name
Employer Address Street / City / State / Zip
Starting Date (mm-dd-yyy)
Employer Phone Number 123-456-7890
Ending Date (mm-dd-yyy)
Position Held At Previous Employer:
Driver
Mechanic
Recruiter
Other
Reason For Leaving

Criminal History

Felony Conviction
Yes | No   Date:
Pending DUI Charges
Yes | No   Date:
Drug Conviction
Yes | No   Date:
Denied a license or permit for operating a motor vehicle
Yes | No   Date:
License or permit been suspended/revoked
Yes | No   Date:
Convicted, or charges pending, for reckless driving or careless operation
Yes | No   Date:
Refused any type of insurance or been denied bonding
Yes | No   Date:
Discharged or suspended while working for another employer
Yes | No   Date:

Additional Comments:



Terms, Conditions, HireRight/DAC and PSP Release

I have read and agree with the terms, conditionsand use of information I am providing, and I give permission to obtain consumer reports about me from HireRight/DAC as well as obtaining information about my driving record from the FMCSA and/or the Pre-employment Screening Program (PSP).
Yes     No




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