Driver Pre-Application For Employment

For fast results fax to (870)216-7101 or call (870)216-0096

Kevin Kidd

Name_____________________________________ Soc.Sec#________________________________________

Address__________________________ City___________________ State_____ Zip______________________

Telephone___________________________ Cell Phone______________________________ D/O/B__________

Date available for employment________ D.L.#_________________________ State______ Exp_____________

CDL? Y/N______ Hazmat? Y/N______ # of tickets in past 5 years_____ #of accidents____________________

Ticket/Accident info (type/date/amount of damage):_________________________________________________

Have you ever been arrested for driving while intoxicated? Y/N______ if yes when________________________

Have you tested positive for controlled substances in the last 3 years? Y/N______ Have you ever had a

License suspended or revoked? Y/N if yes when? _______ Have you ever been convicted of a felony or

misdemeanor? Y/N_______ if yes explain_________________________________________________________

Please list all period of employment for the past 36 months (Driving or Non-Driving, include

additional info on separate paper if needed.)Failure to list all employer info may cause a delay

or denial of your application.

Employed: From_______to_______ Employer____________________________________ Position______________________________

Address_________________________ City____________________ state_____ Zip_________ Phone_____________________________

Type of trailer___________________#of states____________ Reason for leaving______________________________________________

Employed: From_______to_______ Employer______________________________________ Position____________________________

Address_________________________ City____________________ state_____ Zip_________ Phone_____________________________

Type of trailer___________________#of states____________ Reason for leaving______________________________________________

Employed: From_______to_______ Employer_______________________________________ Position___________________________

Address_________________________ City____________________ state_____ Zip_________ Phone_____________________________

Type of trailer___________________#of states____________ Reason for leaving______________________________________________

Did you attend driving school? Y/N_____ Name of school_________________________ Date started__________Ended___________

I certify that I personally completed this application for the purposes of employment and that all information herein is true and correct. I authorize Royal Express to do a complete background investigation in accordance with federal and state law. I authorize release of any information, including all information related to my alcohol and controlled substance testing and training records, by any former employer and hold them harmless of any liability of release of said information. I also consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc. deemed necessary by the company/companies that I am applying for or their subsidiaries in consideration of my employment.

Signature_____________________________Date___________ Referred by: Recruiting edge/_Kevin Kidd