Flatbed Division

• $2,000 sign on bonus
• Travel 4 Southwest States
• Home every week
• .40 cpm to start, .42 cpm after 60 days
• $400 monthly bonus, based on safety and performance
• Hauling building material

Express Way Group Job Application - Flatbed Division

Personal Information

Please enter your personal information accurately so recruiters can contact you easily. Fields in RED are required
First Name:
Last Name:
Address:
City:
State:	Alabama ---------------------- Outside US Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Province:	Not Applicable Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Zip:
Country:	US ------------------ Canada United States
Home Phone:	( ) -
Other Phone:	( ) -
Email:
Date of Birth:	01 -- 01 02 03 04 05 06 07 08 09 10 11 12 - 01 -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 1905 ---- 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988
Social Security Number:	- -

Fields in RED are required

Driving Information

Interested in ...

To increase your exposure to our member companies, please leave OTR checked, unless you will not accept an OTR job. (at least one is required) Local   Regional   Over The Road

Solo   Team   Husband/Wife Team   Owner/Operator

Lease/purchase plan Buying a tractor

CDL Information If you do not have a CDL, please enter your current driver's license number instead.
CDL Number:
CDL State/Province:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
CDL Expiration:	01 02 03 04 05 06 07 08 09 10 11 12 - 2005 2006 2007 2008 2009 2010 2011 2012 2013
CDL Class:	A   B   C   D   none
HazMat Endorsement?	Yes   No
Doubles/Triples Endorsement?	Yes   No
Tank Endorsement?	Yes   No
Passenger Endorsement?	Yes   No

History Record
Has your license ever been revoked/suspended?	Never 1 year ago 2 years ago 3 years ago 4 years ago 5 years ago 6 years ago 7 years ago 8 years ago 9 years ago 10+ years
Number of accidents in last 3 years?	0 1 2 3 4 5 6 7 8
Number of moving violations in last 3 years?	0 1 2 3 4 5 6 7 8
Convicted of a DWI/DUI?	Never 1 year ago 2 years ago 3 years ago 4 years ago 5 years ago 6 years ago 7 years ago 8 years ago 9 years ago 10+ years
Have you ever been convicted of a felony?	Never 1 year ago 2 years ago 3 years ago 4 years ago 5 years ago 6 years ago 7 years ago 8 years ago 9 years ago 10+ years

Owner/Operator Information
If you selected Owner/Operator above...	Tractor Make/Model: Year of Tractor: 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Driving School
Driving School Attended:	none
Did you graduate?	Yes   No
Expected/Graduation date:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Professional Driving Experience
Total Truck Driving Experience:	years 0 1 2 3 4 5 6 7 8 9 10 11 months
Experienced Hauling?	Flatbed   Yes   No Reefer   Yes   No Vans   Yes   No Tank   Yes   No Doubles   Yes   No Heavy Haul   Yes   No Automobile   Yes   No Dry Bulk   Yes   No Dump   Yes   No Livestock   Yes   No Boat   Yes   No

Employment
Please provide the last 3 years of your employment history.

Current/Latest Employer
Company Name:
City:
State/Province:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Phone:
Employed From:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Employed To:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Reason for Leaving:

Employer 2
Company Name:
City:
State/Province:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Phone:
Employed From:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Employed To:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Reason for Leaving:

Employer 3
Company Name:
City:
State/Province:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Phone:
Employed From:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Employed To:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Reason for Leaving:

Employer 4
Company Name:
City:
State/Province:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------ Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Phone:
Employed From:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Employed To:	01 02 03 04 05 06 07 08 09 10 11 12 - 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Reason for Leaving:

Referred By

How did you hear about The Express Way Group?
Referred By:	-Please Select- Google Yahoo MSN AOL Search The Trucker Magazine Job News Magazine A Friend Other
If other, please let us know:
DAC Release: In consideration of your application, the DOT requires an investigation of your employment background. As part of this investigation, consumer reports about you may be obtained from DAC Services. DAC is a consumer reporting agency. DAC does not make any decisions concerning your employment. You have the right to obtain a free copy of the consumer report from DAC and the right to dispute the accuracy or completeness of your report. Your consent to obtain the report from DAC is required. Although you have a right to withhold your consent, this may be considered when reviewing your application. I have read the release and I give my permission to obtain consumer reports about me from DAC. I have read the release and I do NOT give my permission to obtain consumer reports about me from DAC.
Fields in RED are required
I hereby authorize certify that the information included in this application is true and correct.  I hereby authorize, without liability, any persons or company whose name I have given as reference, to furnish Express Way, Inc. any information they may have in regards to my employment.  I hereby release all such persons and organizations from any claims for damages of any type that may occur to me by reasons of furnishing such information. Also in accordance with provisions of 49CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49CFR while in their employment to Express Way, Inc. by whatever means is most expedient. Date: Initials: Your initials will serve as your electronic signature.