Application

First Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Birth Date

Social Security #

CDL Number

CDL State

# of Accidents In Last 3 Years

# of Tickets In Last 3 Years

Tractor Year

Make

Model

Please List Your Last 4 Years Of Over-The-Road Driving Experience
(Dates of Employment, Employer Name, Address, City, State, and Phone)

Please Read and Sign Below:
"As part of our pre-qualification process, B.T.Trucking, Inc. will obtain an investigative consumer report on you. The report may include information regarding your character, general reputation, personal characteristics, and mode of living. B.T.Trucking, Inc. may use the investigative consumer report in whole or in part for the evaluation of the pre-qualification of your application. When you click the 'submit' button below, you authorize B.T.Trucking, Inc. to obtain an investigative consumer report and acknowledge your understanding that B.T.Trucking, Inc. may use the report for pre-qualification purposes. You may request that B.T.Trucking, Inc. completely and accurately disclose to you the nature and scope of the investigation requested. You may also request a written summary of your rights under the Fair Credit Reporting Act. Such request must be made in writing to the Recruiting Department of B.T.Trucking, Inc. within a reasonable time after you submit this occupational work history."

Type your legal name here as you usually sign it. This is your electronic signature:

Signature

Date