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Driver Application Form
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Name
*
First
Last
Date of Birth
*
Date
Time
Must be 21 to apply
Phone
Email
*
Home Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
State
Zip Code
Years of Experience
*
License Number/State
*
SSN
*
Verification if you are eligible for work
Work History
Type of your experience
*
Van
Car Hauling
Flatbed
Heavy Haul
Tanker
Reefer
Other
Company Name
*
Address
*
Address Line 1
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
State
Contact Phone
*
Position Held
*
From Date
*
To Date
*
Please add any additional employers within the last 3 years.
*
Work CERTIFICATION Phone
Any related documents as in CDL/Medical
*
Drag & Drop Files,
Choose Files to Upload
APPLICANT CERTIFICATION & AUTHORIZATION
*
I agree — I am at least 21 years of age and authorize Great Lakes Cargo, Inc. to collect and process the information described above, including my Social Security Number and medical documentation.
By submitting this application, I certify that the information I have provided is true, complete, and correct to the best of my knowledge, and I understand that any false statement, omission, or misrepresentation may result in the rejection of my application or, if discovered after hire, immediate termination of employment. I voluntarily authorize Great Lakes Cargo, Inc. and its agents to collect, verify, store, and use the personal information I have provided — including my Social Security Number, date of birth, driver's license information, employment history, and any medical documentation (including but not limited to DOT medical examination results, Medical Examiner's Certificate, drug and alcohol testing records, and FMCSA Clearinghouse records) — for the purposes of processing my application, conducting pre-employment screening, verifying my qualifications, and complying with all applicable federal and state regulations, including the Federal Motor Carrier Safety Regulations (49 CFR Parts 40, 382, and 391). I further authorize Great Lakes Cargo, Inc. to obtain my motor vehicle record, criminal background report, employment verification, and consumer/investigative consumer reports in accordance with the Fair Credit Reporting Act (FCRA), and to share my information with prior employers, drug and alcohol testing facilities, medical examiners, and government agencies as necessary to complete the application process. I understand that my Social Security Number and medical records will be retained, transmitted, and protected in accordance with applicable privacy laws, and will only be disclosed as required by law or as necessary for the purposes stated above. I acknowledge that I have the right to review the information collected about me and to request a copy of any consumer report obtained in connection with this application. By checking the box below and submitting this application, I confirm that I have read, understood, and agree to the terms above, and that this electronic submission constitutes my legal signature.
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