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
Are you elegible 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

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.