PERSONAL INFORMATION: I am applying: As a recent driving school graduate As an experienced driver Referred by: First Name: Middle Name: Last Name: SS #: Address: City: State:    Zip:    How long have you lived here? Phone:   Cell/Pager: Email: Date of Birth: When is the best time to call you? AM PM How did you hear about us? List all previous addresses for the past five (5) years: Previous address: Address: City: State:   Zip: How Long? Previous address: Address: City: State:   Zip: How Long? Previous address: Address: City: State:   Zip: How Long? Do you possess the legal right to work in the United States?  Yes No Do you read, write and speak the English language?  Yes No   EDUCATION / TRAINING: What is the highest grade completed? 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade College 1-year College 2-years College 3-years College 4-years Did you attend a truck driving school? Yes No If you answered Yes to the previous question: School Name: Date Graduated: Phone: City:    State:   DRIVER'S LICENSE & ENDORSEMENTS: List all motor vehicle operating licenses and permits issued to you in the last five (5) years: Current License Issuing State:     Class:   Number:   Endorsements:   Date Issued:   Date Exp:   Issuing State: Class: Number: Endorsements: Date Issued: Date Exp: Issuing State: Class: Number: Endorsements: Date Issued: Date Exp:   DRIVING EXPERIENCE: Tractor & Semi-Trailer: Refrigerated: Yes No        Van: Yes No         Tank: YesNo    Flat: Yes No           Dump: Yes No Type of Commodities:   Years of Experience: Approx Total Miles Driven: How many driving jobs have you had in the past 3 years?                                                       How many total years have you driven OTR?  How many months have you driven OTR in the past 2 years?                                                         VEHICLE ACCIDENT RECORD: How many accidents have you been involved in, regardless of fault, in the past 3 years? List all motor vehicle accidents (car, truck, motorcycle, etc.) you have had in the past five (5) years. Regardless of which driver was "at fault". YOU MUST PROVIDE THIS INFORMATION. Name of Employer or Person Who Owned Vehicle: Address of Employer or Person Who Owned Vehicle: Date:      Location:   State: Accident Description: Type: Car, Truck, Etc.      $ Dollar Amount Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No Name of Employer or Person Who Owned Vehicle: Address of Employer or Person Who Owned Vehicle: Date:      Location:   State: Accident Description: Type: Car, Truck, Etc.     $ Dollar Amount Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No Name of Employer or Person Who Owned Vehicle: Address of Employer or Person Who Owned Vehicle: Date:      Location:   State: Accident Description: Type: Car, Truck, Etc.     $ Dollar Amount Personal Injuries: Yes NoFatalities: Yes No Were you charged? Yes No   MOVING VIOLATIONS: Have you ever had a driver's license denied, suspended or revoked? Yes No If yes, when? Have you ever been convicted of careless, or imprudent driving? Yes No If yes, when? Have you ever been convicted of any alcohol or drug related charge? Yes No If yes, when? If "yes" to any of the questions listed above, please explain: List all violations of motor vehicle laws or ordinances (other than parking or seat belt violations) of which you were convicted or forfeited bond or collateral during the past five (5) years. Date:    Violation: Location:      Penalty: Vehicle type: Commercial Vehicle Personal/Private Vehicle Date:    Violation: Location:      Penalty: Vehicle_type: Commercial VehicleePersonal/Private Vehicle Date:    Violation: Location:       Penalty: Vehicle type: Commercial VehiclePersonal/Private Vehicle   EMPLOYMENT INFORMATION: Please answer the following questions about your employment history, going back at least 10 years. All Star Transportation must be able to verify the last 10 years. Please list references to verify periods of self-employment or unemployment. Are you currently employed? Yes No Current or most recent employer: Current/most recent employer: Phone: Position: Type of equipment driven: # of States driven in: Starting date:   Pay: City/State: Phone: May we contact your current employer? Contact person: Why do you want to leave?   PAST EMPLOYMENT INFORMATION: Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave? Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave? Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave? Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave? Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave? Past employer: Position: Dates of employment: Pay: City/State: Phone: Contact person: Why did you leave?   MILITARY SERVICE: Branch of Service: Date entered: Date of discharge: Rank at discharge: Job duties:   BACKGROUND INFORMATION: Have you ever been convicted of a misdemeanor? Yes No Have you ever been convicted of a felony? Yes No Do you have any criminal charges pending? Yes No Have you ever refused to take or tested positive on a drug screen? Yes No If yes to any of the above, provide the conviction date(s) and detailed explanation(s): (A conviction will not necessarily be a bar to employment. Factors such as age, nature and severity of the offense(s) will be taken into account.) Are you able to perform the basic duties of an OTR truck driver including loading and unloading?  Yes No Have you ever been named as a defendant in a civil case relating to your employment as a commercial motor vehicle driver?  Yes No If yes, provide the litigation date(s) and detailed explanation(s): Being a defendant in a civil or criminal suit will not necessarily be a bar to employment.)   COMMENTS / QUESTIONS:   CHECK BEFORE SUBMITTING: By clicking the "Submit Application" button below, I certify that I personally completed this application and all information provided is true and correct. I authorize All Star Transportation Co. and all of its affiliates ("All Star Transportation") to conduct a background investigation in accordance with state and federal law, and authorize my previous employers to release any information requested by All Star Transportation and hold them harmless from liability for release of said information. Under CFR Part 382.405 and 382.413, I authorize my previous and/or current employers listed above to release results (including any refusal to test) of all drug/alcohol tests, taken by me while in their employ, to All Star Transportation by whatever means is most expedient. I certify that I have given true, accurate and complete information on this form to the best of my knowledge.