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DART TRUCKING COMPANY
Online General Commodities Application
Personal Information:
First Name:
Middle Name or Initial:
Last Name:
Street Address:
City:
State:
Zip Code:
Home Phone:
Mobile Phone:
Date of Birth:
Social Security Number (To Run MVR):
E-Mail Address:
Best Time to Contact:Drivers License and Safety Record:
License Number:
Expiration Date:
Issuing State:
CDL Class Held:
Hazardous Material Endorsement? (Y/N)
Double/Triple Trailer Endorsement? (Y/N)
Haz Mat Tank Trailer Endorsement? (Y/N)
Passenger Endorsement? (Y/N)
Have you ever had your license revoked or suspended? (Y/N)
Have you had any accidents in the last three (3) years? (Y/N)
Have you ever had a DWI, DUI or BAC in the last seven (7) years? (Y/N)
Have you ever been convicted of a felony? (Y/N)
Have you ever been convicted of a cri me? (Y/N)
If you answered yes to the previous two (2) questions, please give details.
Accident Information:
Date:
Preventable? (Y/N)
Injuries? (Y/N)
Amount of Damage:
Receive Ticket? (Y/N)
Location:
Found at Fault? (Y/N)
Accident Description:
_______________________________________________________________________________________________
Date:
Preventable? (Y/N)
Injuries? (Y/N)
Amount of Damage:
Receive Ticket? (Y/N)
Location:
Found at Fault? (Y/N)
Accident Description:
_______________________________________________________________________________________________
Date:
Preventable? (Y/N)
Injuries? (Y/N)
Amount of Damage:
Receive Ticket? (Y/N)
Location:
Found at Fault? (Y/N)
Accident Description:
Driving School:
Name of Driving School:
Graduation Date:Preferences:
Division Interest:Work Experience:
Current/Most Recent Employer
Company Name:
Street Address:
City:
State:
Zip Code:
Contact:
Phone:
Start Date:
Termination Date:
Position Title:
Pay Rate:
Reason for Leaving:
_______________________________________________________________________________________________
Previous Employer (1)
Company Name:
Street Address:
City:
State:
Zip Code:
Contact:
Phone:
Start Date:
Termination Date:
Position Title:
Pay Rate:
Reason for Leaving:
_______________________________________________________________________________________________
Previous Employer (2)
Company Name:
Street Address:
City:
State:
Zip Code:
Contact:
Phone:
Start Date:
Termination Date:
Position Title:
Pay Rate:
Reason for Leaving:
Please print this application and fax to:
Dart Trucking Company, In
ATTN: Chris Knupp
Fax Number: 330-482-7090