Fully complete Experience and Qualifications section! Do not leave blank boxes!

Driving and Employment Experience:

Full name, street or mailing address, and city and state of each employer listed.
Telephone number, and if you have it, the fax number.
Position held – show what type truck/trailer you drove.
From – To needs to have month and year of employment.
Must show previous employers for past 10 years, starting with most recent employer and going back in time.
Be sure to read Amendment A and B and check boxes to verify compliance and/or understanding.
Pre-employment DOT Drug Tests, and DOT Physicals are to be paid by the driver!

Personal Information
First Name:*
Last Name: *
Home Address: *
City: *
State/Provience: *
Zip: *
How Long at Address: *
Social Security Number:*
Date of Birth:*
Home Phone: *
Other Phone:
Previous Address (if less then 3 years at current address)
Previous Address:
City:
State/Provience:
Zip:
How Long at Previous Address:

CDL Information
CDL #*
CDL State*
CDL Type*
CDL Expiration Date*
Previous CDL Information (if applicable)
Previous CDL #
Previous CDL State
Previous CDL Type
Previous CDL Expiration Date

OTR Driving Experience
Type of Equipment (Van, Tank, Flat, etc...)*
Date From *
Date To*
Approximate Number of Miles *
Tractor and Semi-Trailer Experience
Type of Equipment (Van, Tank, Flat, etc...)*
Date From *
Date To*
Approximate Number of Miles *
Tractor: Two-Trailer Driving Experience
Type of Equipment (Van, Tank, Flat, etc...)*
Date From *
Date To*
Approximate Number of Miles *
Other Driving Experience
Type of Equipment (Van, Tank, Flat, etc...)*
Date From *
Date To*
Approximate Number of Miles *

Accident Record for last 3 years or more If you have additional information for this or any section, please mail us any attachments or fax it to 870-802-2190.
Date of Accident
Nature of Accident (Head-On, Rear-End, Upset, etc...)
Fatalities
Injuries

Date of Accident
Nature of Accident (Head-On, Rear-End, Upset, etc...)
Fatalities
Injuries

Traffic Convictions and Forfeitures for the last 3 years (Other than parking violations) If you have additional information for this or any section, please mail us any attachments or fax it to 870-802-2190.
Location
Date
Charge
Penalty

Location
Date
Charge
Penalty
Additional Driving Information If the answer to either question is "yes", please please mail or fax a statement giving details.
Have you ever been denied a license, permit or privilege to operate a motor vehicle? *
Has any license, permit or privilege ever been suspended or revoked? *

Work History (Three years verifiable) If you are a recent driving school graduate, list the driving school you attended as one of your work experiences
Current or Most Recent Employer
Company Name: *
City: *
State/Provience: *
Phone:
Position Held:
From Date *
To Date: *
Reason For Leaving:
Employment Record 1
Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date
To Date:
Reason For Leaving:
Employment Record 2

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:
Employment Record 3

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:
Employment Record 4

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:
Employment Record 5

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:
Employment Record 6

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:
Employment Record 7

Company Name:
City:
State/Provience:
Phone:
Position Held:
From Date:
To Date:
Reason For Leaving:

Amendment A
Have you ever tested positive, failed, or refused a drug/alcohol test as required by U. S. D. O. T. regulations, for pre-employment, random, or for any other reason? *
Have you ever been convicted of use or possession of a controlled substance? *
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *
Have you ever been convicted of a felony? *
If so, what was the charge? *

DRIVER QUALIFICATION I certify that I have personally read and understand the Qualifications for Employment with Loggins Logistics, Inc. Note: If you have not read the Qualifications for Employment or did not understand them, please click here and review them and if after reading you still have questions, please contact Loggins Logistics, Inc. at 870-932-9231 and we will address any inquries or concerns that you have regarding employment.

DISCLAIMER I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize any company that receives this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold Loggins Logistics harmless of all liability for providing this application for my use.

Please click the "Submit Application" button only once and allow time for the form to process.

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