Welcome to Continental Express - Driver Application

Date: Date of Birth:
Name:
Social Security #:
City:
State:	Zip:
E-mail:
Phone:
Best Time to be Reached:
No. of Years Driving OTR:
Type of Experience:	Van: Flatbed:
License #:
Class:	State:
Hazmat:	Yes: No:
Had and license, permit, or privilege suspended or revoked? Yes: No:
Have you ever been convicted of a felony? Yes: No:
Have you ever been cited for a DUI or DWI? Yes: No:
Have you ever tested positive or had results reported positive on any DOT drug or alcohol test? Yes: No:


Past Employer 1:
Company:
Phone #:
City:
State:	Zip:
Dates:	From: To:
Position Held:
Type of Trailer:
No. of States:
No. of Accidents or Incidents:
Please Explain:
Reason for Leaving:


Past Employer 2:
Company:
Phone #:
City:
State:	Zip:
Dates:	From: To:
Position Held:
Type of Trailer:
No. of States:
No. of Accidents or Incidents:
Please Explain:
Reason for Leaving:

I hereby certify that this information is correct and complete to the best of my knowledge. I authorized Continental Express Inc. to obtain informatiion to my past or present work history, and to do a complete background investigation in accordance with state and federal laws. Furthermore, I give my express consent for consent for DAC Services, any previous employer, their agent, Medical Review Officer or their agent to release information concerning any of my past controlled substance tests. I release all persons from any liability or damage. E.O.E.

Agree: Disagree: