Application

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Do you have a Class A CDL?

How much OTR driving experience in the past 3 years?

Have you had any DUIs in the past five (5) years?

Were you terminated from your last job?

Yes

No

How many preventable accidents have you had in the past 2 years?

How many moving violations have you had in the past 3 years?

Name of your previous or current employer

Previous or current employers phone #

(###)

###

####

You will also need to fill out a driver packet which consists of documents that are required for employment with Primeway Logistics.