Stidham Trucking Inc. - Driver Recruitment Program

Stidham Trucking, Inc. Driver Recruitment Program Application

Driver Qualification Proposal: Personal Information

This Application Form contains 5 pages, which you can fill out and submit by e-mail. Before completing these Application Form pages, please read these instructions:

This form must be completed by the applicant only.
Type answers clearly in each provided space.
Be sure to answer each question. Questions that are unanswered or that have incomplete answers may disqualify the applicant. This is particularly true of the questions about work history, drivers licenses, license suspensions, tickets and accidents.
Applicant is aware that inquiries will be made to all prior employers and lessees for the purpose of investigating the applicant's background. DOT rule 391.21 (b)(11) and 391.23.
If additional space is required to answer any question, please use the comment box at the bottom of this form.
Applicant is aware that a urine sample will be collected and tested for the presence of controlled substances in accordance with FMCSR 391 Subpart H.

I have read the instructions and understand them.
Submission of this form constitutes the applicant's legal signature.

I am proposing to operate as an Independent Contractor.

Name:
Your email:
Telephone (with area code):
Date of Birth:
DOT Rule 391.21 (B)(2) requires date of birth on application. DOT Rule 391.11 (B)(1) requires drivers to be at least 21 years old.
Social Security Number:
Present Address (street, city, state, zip):
Below list all other addresses for the past 5 years. Indicate how long at each.
Previous Address 1 (street, city, state, zip):
How long:
Previous Address 2 (street, city, state, zip):
How long:
Previous Address 3 (street, city, state, zip):
How long:

Have you ever been known by any other name, other than the one appearing on the application?	No: Yes:
If yes, what name?

Have you ever submitted an application to Stidham Trucking before?	No: Yes:
If yes, when and what results?

Have you ever been discharged, terminated or suspended from any position you have ever held?	No: Yes:
If yes, explain.

Have you ever been convicted of any offense or crime, other than a motor vehicle violation?	No: Yes:
If yes, please indicate date of conviction, location, offense, and penalty.
Convictions will not automatically disqualify applicant.
Are you a US citizen?	Yes: No:
If no, do you have the right to remain in the US?	Yes: No:
Do you have a current work permit?	Yes: No:

How were you referred to us?
What compensation do you expect?
In case of emergency, please contact:
Name, address and telephone.

After submitting Personal Information above, please continue with page 2 of the Application Form: Drivers License Information

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	WESTERN DIVISION P.O. Box 308 Yreka, California 96097 1-800-827-9500 530-842-4161 FAX 530-842-2047
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