CAREERS

PERSONAL INFORMATION

Name

First

Middle

Last

Phone

Email

Address

Address Line 1

City

State

Zip Code

Have you lived at this address for less than 3 years?

Social Security Number

Date of Birth

PERSONAL INFORMATION (CONT.)

Have you worked for Light Express LLC before?

If yes, when?

CDL INFORMATION

CDL Information

CDL#

Expiration Date

CDL State

Current CDL# for less than 3 years?

DOT MEDICAL CARD INFORMATION

DOT Medical Card Expiration Date

Upload DOT Medical Card

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EXPERIENCE

Truck-Tractor

Equipment Type

Date From

Date To

Approx Miles

Semi-Trailer

Equipment Type

Date From

Date To

Approx Miles

Doubles/Triples

Equipment Type

Date From

Date To

Approx Miles

Other

Equipment Type

Date From

Date To

Approx Miles

ACCIDENT / CRASHES

Have you had any accidents/crashes in the last 3 years?

MOVING TRAFFIC VIOLATIONS

Have you had any traffic violations in the last 3 years?

FORFEITURES

Have you ever been denied a license, permit, or privilege to a motor vehicle?

Has any license, permit, or privilege ever been revoked?

MOST RECENT PREVIOUS EMPLOYER

Employer Name

Address

Address Line 1

City

State

Zip Code

Layout

Phone

Fax

Email

Layout

Position Held

Date From

Date To

Reason For Leaving

Were you subject to the FMCSR's while employed by this carrier?

Was your job designated as a safety sensitive function, in any DOT regulated mode, subject to the alcohol and controlled substances testing requirements?

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