TruckinUSA Online
Driver/Owner-Operator Application


If you are looking for a change in employment or would like to "keep your options open" use this online form to apply to many trucking companies at once.

Your application will be sent to the companies participating in our online recruitment program.

Name:
Last :
First :
Middle :
Social Security:
Email Address:
Present Address:
Street :
City :
State :
Zip Code:
Phone Number:

Equipment:

Fill out only if
you currently own equipment

Make of Tractor

Year of Tractor

Tractor HP

Year of Trailer

Drivers License Information:
License #: State: Expiration:
Date of Birth: Hazardous Materials: YES NO

Experience Level
Years:
Type: VAN FLATBED REEFER
Approx. No. of Miles:
Convictions, Insurance Liability?
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
Have you ever had any license permit or privilege suspended or revoked? Yes No
Have you ever been convicted for driving while under the influence of alcohol or drugs? DATE: Yes No
Have you ever been refused liability insurance? Yes No
Have you ever been convicted of a felony or misdemeanor? Yes No
Have you ever been disqualified to drive by Federal Regulations? Yes No
Have you ever been refused a security bond? Yes No
If you answered yes to any question , please state details, circumstances, and date:

Accident Information:
Have you had any accidents in the past 3 years? Yes No

Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Chargeable: Yes No
Major Or Minor?:
Minor(under $5,000.00 and no injuries)
Major(over $5,000.00 with injuries) 		Major Minor

Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Chargeable: Yes No
Major Or Minor?:
Minor(under $5,000.00 and no injuries)
Major(over $5,000.00 with injuries) 		Major Minor

Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Chargeable: Yes No
Major Or Minor?:
Minor(under $5,000.00 and no injuries)
Major(over $5,000.00 with injuries) 		Major Minor

Number of Traffic Violations in Last 3 years: Excluding Speeding Tickets
Date: Location(State):
Charge: Penalty:
Date: Location(State):
Charge: Penalty:
Date: Location(State):
Charge: Penalty:

Number of Speeding Tickets in Last 3 years:
Number of Speeding Tickets
Number that were excessive (15 mph over the speed limit)

Employment History For 3 Years
Current Or Last Employer/Leasor:
Company Name:
Address:
City:
State: Zip Code:
Dates of Employment: From: To:
Phone Number:
Supervisor:
Type of Equipment Operated: Straight Truck
Tractor Trailer Combination
Tanker
Flat Bed
Number of States Driven: 2-5 6-10 11-15 48 plus Canada
Reason for Leaving:
Next Previous Employer
Company Name:
Address:
City:
State: Zip Code:
Dates of Employment: From: To:
Phone Number:
Supervisor:
Type of Equipment Operated: Straight Truck
Tractor Trailer Combination
Tanker
Flat Bed
Number of States Driven: 2-5 6-10 11-15 48 plus Canada
Reason for Leaving:
Next Previous Employer
Company Name:
Address:
City:
State: Zip Code:
Dates of Employment: From: To:
Phone Number:
Supervisor:
Type of Equipment Operated: Straight Truck
Tractor Trailer Combination
Tanker
Flat Bed
Number of States Driven: 2-5 6-10 11-15 48 plus Canada
Reason for Leaving:

Do NOT submit my name to the following companies:

Disclaimer

I certify that I personally completed this application and that all of the information is true and correct. I authorize any company or their agents that receive this application to obtain any and all information in accordance with state and federal laws. I authorize my previous employers to release any information required by companies or their agents, receiving this application through Truckin USA, and hold them harmless of all liability from the release of said information. I have completed this application of my own free will and hold Truckin USA harmless of all liability for proccessing and providing this information and application.