Bennett Motor Express, LLC
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Personal Information

Contact Information
*Full Name:
*Address 1:
Address 2:
*City: *State: *Zip:
Day Phone: *Cell Phone:
Night Phone: Pager:
*Email: Best time to call:
*SSN:
 Secure Site *Date of Birth:
*How did you hear about us?
Who Referred You?
CDL Information
*Do you have a CDL?   Yes   No CDL Number:
Issue State: Expiration Date:
Check all that apply to your current CDL:
Class A Endorsements:
Passenger Tanker Haz. Mat Doubles Bus
Class B
Driver Information
*Are you a U.S. Citizen? Yes   No *Are you legally eligible for contracting in this country? Yes   No
*Do you have military experience? Yes   No Military Branch:
Are you eligible to do border crossing? Yes   No Do you have a TWIC Card? Yes   No
Do you have a passport? Yes   No Over-dimensional permitted vehicles? Yes   No

Experience and Preference

Total OTR years:
Tractor Type Experience and Preference
Straight Truck: Years Tractor & Semi Trailer: Years School Bus: Yes   No
Air Brakes: Yes   No Manual Transmission: Yes   No City/Highway Coach: Yes   No

Employment History

Work Record for Past Ten (10) Years

Your Work History will be carefully checked for the past 36 months. All 36 months must be accounted for, including self-employment or unemployment, indicate individuals we may contact, and supply us with phone numbers including area codes. Use the comments section at the bottom of this application to provide us with any additional information.

I am currently employed. Number of jobs in last 3 years
Current Employer
Employer name:
Address Phone
City State Zip
Start date End date
Position held
Supervisor You may contact this employer
Reason left *Were you subject to FMCSA guidelines?:
Yes   No
Vehicle driven *Was this position designated Safety Sensitive Function?:
Yes   No
Previous Employer#1
Employer name :
Address Phone
City State Zip
Start date End date
Position held Pay rate
Supervisor
Reason left *Were you subject to FMCSA guidelines?:
Yes   No
Vehicle driven *Was this position designated Safety Sensitive Function?:
Yes   No
Previous Employer#2
Employer name :
Address Phone
City State Zip
Start date End date
Position held Pay rate
Supervisor
Reason left *Were you subject to FMCSA guidelines?:
Yes   No
Vehicle driven *Was this position designated Safety Sensitive Function?:
Yes   No
Previous Employer#3
Employer name :
Address Phone
City State Zip
Start date End date
Position held Pay rate
Supervisor
Reason left *Were you subject to FMCSA guidelines?:
Yes   No
Vehicle driven *Was this position designated Safety Sensitive Function?:
Yes   No

Driving History

Accidents (Past 5 years) Traffic Convictions (Past 5 Years)
Date Nature of Accident Injury Fatality Date Location Charge Penalty
Traffic Convictions
Number of tickets received
*DUI or DWI? Yes   No
Criminal Record
If so, when...
*Have you ever been convicted of a felony? Yes   No
*Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes   No
*Have you ever been convicted of a crime or have any charges pending? Yes   No
*Has any license, permit or privilege ever been suspended or revoked? Yes   No
*Have you ever tested positive or refused a test for drugs or alcohol? Yes   No
*Have you ever abandoned your equipment? Yes   No
**If you answered yes to any of the above, please explain in the comments box below.

Comments:

*I have read and agree to the above and give permission to obtain consumer background reports about me from sources/agencies referenced above.
Yes   No
If you are experiencing any issues with the application process, please call our recruiting department at 800-367-2249.