Now accepting applications for owner operator and company drivers.

Position Applying For?	Company Owner Operator
Preferred Route:	Local Regional Long Haul
Name:
Social Security #:
DOB (mmddyyyy)
Phone #:
Mobile #:
E-mail Address:

License Information

State License Issued:
License Number:
Type:
License Dated (mm/dd/yy):
City/ Zip Code:

Current Address

Street:
City/Zip Code:
State:
How long did you live there? (mm/yyyy):

Previous Address:

Street:
City/Zip Code:
State:
How long did you live there? (mm/yyyy):

Experience

Do you have tractor-trailer experience?	Yes No
Have you worked at ATC before?	Yes No
Number of Years of Employment:
Last year worked?
Present/Last Employer:
Employed from:
Employed to:
Position:
Supervisor:
Street:
Company:
Street:
City/Zip Code:
State:
Phone #:
Reason for leaving:
May we contact this employer?	Yes No
Previous Employer:
Employed from:
Employed to:
Position:
Supervisor:
Company:
Street:
City/Zip Code:
State:
Phone #:
Reason for leaving:
May we contact this employer?	YesNo

History

Have you failed or refused a drug or alcohol test?`	YesNo
If yes, when? (mm/yyyy)
Do you have any Felony Convictions?	YesNo
If yes, date of last felony. (mm/yyyy)
List all felony charges with their dates (mm/yyyy) and a brief description:
Do you have any Misdemeanor Convictions?	Yes No
List all misdemeanor charges with their dates (mm/yyyy) and a brief description:
List all moving violations in the past 3 years:
List number of accidents in the past 3 years:
Did you speak with a recruiter?	Yes No
If so, who?
List any referrals:
How did you hear about ATC?

I certify that I personally completed this application and that all of the information is true and correct. I have read the Physical Requirements for Position and can meet these requirements. I have read the DAC and ATC's Disclosure and Release forms and agree to their terms. Please contact Safety Director: Jerry Huber to obtain a copy of these forms if necessary. By checking yes, and submitting this application I also authorize the release of all alcohol and controlled substance testing results (or refusals to test) pursuant to 382.413 of the Federal Motors Carriers Safety Regulations and release this company from any and all liability of any type as a result of providing the above mentioned information to the above mentioned person.

Yes

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