Sprinter Trucking Driver Application

Personal Infomation
Type of Driver:	Company Driver Student Graduate Owner/Operator
First/Middle Name:		Last Name:
Street Address:
City:		State:	Zip:
Birth date:		SSN:
Phone #:		Email Address:
Professional Driving Infomation
License #:		State:
# Years Driving:		# Moving Violations:
Last DOT Physical:
# Preventable Accidents:		DUI/DWI?:
Felony Conviction?		Conviction Date?
How did you hear about Sprinter Trucking Company?
Employment History (Last 3 Employers)
Company:		Phone #:
City:		State:	Zip:
Position:
Employed From:		Employed To:
Termination Type:
Reason for Termination:

Company:		Phone #:
City:		State:	Zip:
Position:
Employed From:		Employed To:
Termination Type:
Reason for Termination:

Company:		Phone #:
City:		State:	Zip:
Position:
Employed From:		Employed To:
Termination Type:
Reason for Termination:
Owner-Operator Partner Information
Make of Truck
Age of Truck
Truck Weight

TO BE READ AND AGREED UPON BY APPLICANT

It is agreed and understood that any misrepresentation of information given shall be considered an act of dishonesty. It is agreed and understood that the carrier or its agents may investigate the applicant's background to ascertain any and all information of concern to the applicant's record, whether same is of record or not, and applicant releases carrier and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application for qualification file. (PENNSYLVANIA RESIDENTS ONLY) I authorize the carrier to obtain from the Registry of Motor Vehicles a copy of my motor vehicle violations record. It is agreed and understood that this application for qualification under the DOT Regulations in no way obligated the carrier to qualify me, and it is understood that if qualified, I may be on a introductory period during which time I may be released without recourse. I agree and authorize previous employers to release and forward all information on my alcohol and controlled substance testing. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I have read and understand the above and have filled out this application truthrully to the best of my knowledge.

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