USA Truck Driver Application Form

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PERSONAL INFORMATION
* Name:
Email:
SSN:
* Phone:
Date of Birth:
Address 1:
Address 2:
City:
State:
Zip:
How many years of tractor-trailer experience do you have?

REFERRAL INFORMATION
Have you spoken to a USA TRUCK Recruiter?	Yes No
If so, what is the name of the USA TRUCK Recruiter ?
PRESENT EMPLOYER INFORMATION
May we contact your present employer?	Yes No
Name of present employer:
City where employed:
State where employed:
From:
To:
Position:
Work phone:
Equipment operated:
PREVIOUS EMPLOYER 1
Name of previous employer 1:
City where employed:
State where employed:
From:
To:
Position:
Work phone:
Equipment operated:
PREVIOUS EMPLOYER 2
Name of previous employer 2:
City where employed:
State where employed:
From:
To:
Position:
Work phone:
Equipment operated:

DRIVING RECORD
Current Driver's License Number:
Current Driver's License State:
CDL?	Yes No
Endorsements?
Number of Moving Violations (Last 3 years):
Number of Accidents (Last 3 years):
Have you ever been convicted of a felony?	Yes No
If yes, when?
Have you ever had a DUI/DWI?	Yes No
If yes, when?
Have you ever had your drivers license suspended?	Yes No
Have you ever had a criminal conviction?	Yes No
If yes, please explain:
I hereby certify that all questions answered are correct, and authorize USA Truck, Inc. to contact my former employers, references furnished, and all other sources that they see fit, in order to verify the facts and information furnished with regard to my character and qualifications. In connection with my application for employment (including contract for services) with you , I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. I understand that the completion of this form or any other application form of the company does not assure me of a position with said company or obligate the company in any way.