DRIVER QUALIFICATION APPLICATION

If you are looking for a change in employment or would like to "keep your options open" use this online form to send an online qualification profile to Central Transportation Services or one of its fleet operators.

Application will be sent to CTS and 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

 
Drivers License Information:
License #: State: Expiration:
Date of Birth:  
Endorsements:
Current License CDL Class: YES NO
Combination vehicles over 26,001 lbs.: YES NO
Hazardous Materials: YES NO
Air Brakes: YES NO
Experience Level
Years:
Type: VAN FLATBED REEFER TANK PNEUMATIC
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 crime? 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
Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Date: Injuries: Yes No
Nature of Accident: Preventable: Yes No
Number of Traffic Violations in Last 3 years:
Date: Location(State):
Charge: Penalty:
Date: Location(State):
Charge: Penalty:
Date: Location(State):
Charge: Penalty:
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:
Number of States:
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:
Number of States:
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:
Number of States:
Reason for Leaving:

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 CTS 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 CTS harmless of all liability for proccessing and providing this information and application.