Online Driver PRE-Application Form

Name:
Address:
City:	State:	Zip Code:
Telephone Number:
Your email address:
Do you have the legal right to work in the United States?		Yes No
CDL State: CDL Number:
Do you have your Hazardous Materials Endorsement?		Yes No
Have you ever been convicted of a felony that would disqualify you from obtaining or maintaining your hazardous materials endorsement?		Yes No
Are you at least 25 years of age?		Yes No
Do you have at least 1 yr. recent verifiable tractor-trailer experience?		Yes No
Do you have more than two moving violations in the past three years?		Yes No
How many motor vehicle accidents have you been involved in in the past three years?		0 1 2 3
Have you ever been denied a license or permit to operate a motor vehicle?		Yes No
Has your license, permit, or driving privileges been suspended within the past three years?		Yes No
Have you been convicted of a DUI/DWI within the past seven years?		Yes No
Have you ever refused or tested positive on an alcohol or drug test while employed by a motor carrier?		Yes No
Have you ever worked for Air-Land Transport Service, Inc. or Gray Interplant?		Yes No

Employers

Please list all employers in reverse order in the box below.
Please include company name, address, and telephone number.

Company:
Address:
City/State/Zip:
Phone:
Position:

Company:
Address:
City/State/Zip:
Phone:
Position:

Company:
Address:
City/State/Zip:
Phone:
Position:

Company:
Address:
City/State/Zip:
Phone:
Position:

Company:
Address:
City/State/Zip:
Phone:
Position:

Additional Comments:

I authorize Air-Land Transport Service, Inc. to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Air-Land Transport Service, Inc. I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that this submission does not in any way constitute an employment contract or an offer of employment. I understand that I must meet all applicable federal, state, and Air-Land Transport Service, Inc. requirements.

Yes No

I acknowledge by my electronic signature that I have read and understand the above disclosure and authorize Air-Land Transport Service, Inc. to verify and obtain necessary required information for employment purposes.

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