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Online Driver Application
367 Powdermill Creek Road
Newland, NC 28657
Phone: (828) 733-2169
Fax: (828) 733-6467
Office Hours:
Monday - Friday 8:00AM to 5:00PM
First Name:
Initial:
Last Name:
Address:
Address:
City:
State:
Zip:
Date of Birth:
Social Security Number:.
Phone:
Cell:.
License State:
Commercial License Number:
Do you have flatbed experience?
Flatbed Experience Information (Include number of Years Experience):
Number of Moving Violations in the last 3 years:
Accidents:
Number Preventable:
Any history of DUI or Reckless Driving?
Any License Suspension in the Last 3 Years?
If Yes to License Suspension or DUI Please Explain:
Have You Ever Been Convicted of a Felony?.
If yes, please explain:
Previous Driving Experience:
3 years required. Start with current employer:
Start Date:
End Date:
Employer:
Address:
Address:
City:
State:
Zip:
Phone:
Supervisor
Rate of Pay:
Reason for Leaving:
Start Date:
End Date:
Employer:
Address:
Address:
City:
State:
Zip:
Phone:
Supervisor
Rate of Pay:
Reason for Leaving:
Start Date:
End Date:
Employer:
Address:
Address:
City:
State:
Zip:
Phone:
Supervisor
Rate of Pay:
Reason for Leaving:
Start Date:
End Date:
Employer:
Address:
Address:
City:
State:
Zip:
Rate of Pay:
Reason for Leaving:
Supervisor
Phone:
Start Date:
Employer:
Address:
Address:
City:
Phone:
Rate of Pay:
End Date:
State:
Zip:
Supervisor
Reason for Leaving:
Comments or Questions:
Can your current employer be contacted?
Can previous employers be contacted?
By submitting this application, which is electronically submitted without signature, I certify that I have personally completed this application and all of the information is true and correct. I authorize Pittman Trucking to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Pittman Trucking and hold them harmless of any liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me to release the results (Including any refusal to test) of all drug and alcohol tests
* I Have read, understand and agree to the submission release: