DRIVING EXPERIENCE (1 Year minimum)
Type of Equipment	Years of Experience
Straight Truck
Tractor & Semi-Trailer
Truck & Full Trailer
Other (Specify)

WORK HISTORY Please answer the following questions and fill out the information requested.
1. Have you ever been denied a driver’s license, permit or privilege to operate a motor vehicle?	YES NO
2. Has any driver’s license, permit or privilege ever been suspended or revoked?	YES NO
3. Have you ever been convicted for possession, sale or use of a narcotic drug, amphetamine, or derivative there of, or have a current charge pending?	YES NO
4. Have you ever been refused auto liability insurance?	YES NO
5. Have you ever been convicted or a crime, or have a current charge pending?	YES NO

If the answer is yes to any of the Questions 1 through 5, state the circumstances and date.

List all driver’s licenses held in the past five years:

List all traffic convictions, forfeitures or suspensions of driver’s license in a truck or car (other than parking violations) for the past five years. If none, type "none" below.

List all of the accidents you have been involved in, whether operating a truck, car, motorcycle, or other motorized vehicle, include all accidents, whether you were at fault or not. If you have no accident record, write "None."

List all of your work history for the past 3 years. Begin with your present or most recent employment, then work backwards. All time must be accounted for, including unemployment.                                         Present (Last)
Name of Company:
Company Area Code & Ph #:
Company Address:
City, State ZIP:
Date Employment Began:
Date Employment Ended:
Reason for Leaving
Job Classification
Equipment Operated	2'nd (Job before Last)
Name of Company:
Company Area Code & Ph #:
Company Address:
City, State ZIP:
Date Employment Began:
Date Employment Ended:
Reason for Leaving
Job Classification
Equipment Operated	3'rd
Name of Company:
Company Area Code & Ph #:
Company Address:
City, State ZIP:
Date Employment Began:
Date Employment Ended:
Reason for Leaving
Job Classification
Equipment Operated

                                     Statement of Understanding
I certify that I personally completed this application and that all of the information is true and correct. I authorize Wenger Truck Line, Inc. to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officer or their agent, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by Wenger Truck Line, Inc. and hold them harmless of all liability from release of said information. I have read and understand the above statements and acknowledge by affixing my digital signature below.

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