Trans-United Specialized Hauling

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Personal Information
First Name	Middle Inital	Last Name
Address	City	State	Zip
Social Security Number - -	Date of Birth / /
Home Phone - -	Cell Phone - -
Email

Emergency Contact
First Name	Relationship
Address	Home Phone - -		Cell Phone - -

Tractor Information
Make	Model		Year
Color	Wheel Base		Weight
Air Ride? yes no	VIN #
Date of last DOT Inspection	Name on Title

Additional Equipment
Headache Rack? yes no	Oversized signs/flags? yes no
# of Tarps/Size	# of Chains/Size		# of Snap Binders
# of Strap/Size	# of Ratchet Binders

Trailer Information
Make	Type		Year
Color	VIN #
Empty Weight	Air Ride? yes no		Length	Width	Height

Commercial Drivers License Information
CDL Number	State	Expiration /		Type
Endorsments
Has your CDL ever been suspended or revoked? yes no			If yes, please explain:
Have you ever driven for this company before? yes no			If yes, when:
Do you have "Heavy Haul" experience? yes no
May we contact your current employer? yes no

Additional Questions
Have you ever been convicted of a felony? yes no			If yes, please explain:
Have you ever tested positive for drugs or alcohol? yes no			If yes, please explain:
Have you ever refused a drug or alcohol test? yes no			If yes, please explain:
Have you completed the DOT SAP requirements? yes no
Have you been convicted of a DWI or DUI? yes no

Education
Highest grade completed:
List special courses or training
List special equipment or technical materials you can work with

Driving Experience
Class: Straight Truck Trailer Type	Dates From/To		States Driven
Class: Tractor & Semi-trailer Trailer Type	Dates From/To		States Driven
Class: Other Trailer Type	Dates From/To		States Driven

Traffic Convictions/Forfeitures
List all Convictions and Forfeitures in the past 3 years (If none, write none)
Location	Date /	Charge			Penalty
Location	Date /	Charge			Penalty
Location	Date /	Charge			Penalty

Accidents
List accidents in the last 3 years (If none, write none)
Nature of accident	Date /	Fault?	Injuries		Fatalities
Nature of accident	Date /	Fault?	Injuries		Fatalities
Nature of accident	Date /	Fault?	Injuries		Fatalities

Work History
Work Experience - All driver applicants must list 10 years of work history in accordance with §391.21 & .23 of the Federal Motor Carrier Safety Regulations. List current employer first

Work Experience 1
Name	Position Held		From /		To /
Address	City	State	Zip
Contact Person	Phone Number - -
Salary	Reason for Leaving
Were you subject to the FMCSR's while employed? yes no
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements for 49 CFR part? yes no

Work Experience 2
Name	Position Held		From /		To /
Address	City	State	Zip
Contact Person	Phone Number - -
Salary	Reason for Leaving
Were you subject to the FMCSR's while employed? yes no
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements for 49 CFR part? yes no

Work Experience 3
Name	Position Held		From /		To /
Address	City	State	Zip
Contact Person	Phone Number - -
Salary	Reason for Leaving
Were you subject to the FMCSR's while employed? yes no
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements for 49 CFR part? yes no

Work Experience 4
Name	Position Held		From /		To /
Address	City	State	Zip
Contact Person	Phone Number - -
Salary	Reason for Leaving
Were you subject to the FMCSR's while employed? yes no
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements for 49 CFR part? yes no

Submit Application
By submitting online form via email, this certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge, I authorize Trans United inc. to make such investigations and inquiries of my personal, employment, financial, or medical history, and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, healthcare providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that information I provide regarding current and/or previous employers may be used and those employer(s)will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (a) and (e). I understand that I have the right to: Review information provided by previous employers Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the Information In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company. To release the following information to TransUnited, Inc. for the purposes of investigation as required by section §391.23 and allowed by section §383.35 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may result from furnishing such information.
Applicants Name		Date / /