General Information
First Name *
Last Name *
Date of Birth *
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Address *
City *
State *
Select State
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AL
AR
AZ
CA
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CT
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DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
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MO
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MT
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WY
Zip Code *
Phone Number *
Best time to call *
Email Address *
Are you a U.S. citizen? *
Yes
No
If NO, do you have a permanent resident card?
Yes
No
Driving Experience
Do you have experience in freight delivery? *
Yes
No
If YES, please describe.
Vehicle Status
Do you own an Expedite Truck? *
Yes
No
If YES, describe Truck Type.
Cargo Van
Sprinter
Cube Van
Straight Truck
Tractor Trailer
Truck Year(s)
Driver's License and History
Current Driver's License Number *
Issuing State *
Select State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
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
Expiration Date *
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2009
2010
2011
2012
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2020
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2022
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2029
2030
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Is this a CDL? *
Yes
No
Besides the current license listed above, have you had any other driver's licenses in the last three years? *
Yes
No
If YES, list driver's license numbers and issuing states for the past three years.
Have you had any moving violations in the last three years? *
Yes
No
If YES, how many?
Have you had any vehicular collisions in the last
three years? *
Yes
No
If YES, how many?
Have you ever had a DUI / DWI / OWI? *
Yes
No
If YES, when?
Have you ever failed / refused a drug test? *
Yes
No
If YES, when?
Have you ever been convicted of a crime? *
Yes
No
If YES, please explain.
Are you currently contracted to another carrier? *
Yes
No
If YES, please list carrier(s).
If you would like to provide any additional information, please enter it here.
By checking this box, I agree that the information provided above is true and accurate to the best of my knowledge. *
Yes