APPLY NOW Driver Pre-Application Thank you for taking the time to begin your application as a driver for Mid Continent Trucking.First Name(Required) Middle Name Last Name(Required) Address 1(Required) Address 2 City(Required) State(Required)- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZipcode(Required) Phone Number(Required)Email Address Date of Birth(Required) MM slash DD slash YYYY Current or Most Recent Employer Employer City Employer State- None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingTractor Trailer Job?- None -YesNoNumber of Preventable Accidents in Past 3 Years Number of Moving Violations in Past 3 Years For California applicants: Please do not disclose misdemeanor convictions for marijuana-related offenses that are more than 2 years old, convictions that have been expunged, sealed, or statutorily eradicated; misdemeanor convictions for which probation has been successfully completed or discharged, and the case has been judicially dismissed; or Any referrals to a diversion program. Have you ever been convicted of or are charges currently pending for any of the following:A Felony? Yes No A Misdemeanor? Yes No Reckless Driving? Yes No Possession, Sale, or Use of Drugs? Yes No A DUI, DWI, or Any Other Alcohol Related Offense? Yes No Have you ever tested positive for drugs or alcohol or refused a drug or alcohol test? Yes No Has your license ever been suspended? Yes No If yes, please explain and include dates of license suspension.I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application and/or drug & alcohol testing information in accordance with FMCSA regulations. By signing below, I certify that; (i) all information provided herein is complete and accurate; (ii) I have read and fully understand Part I, DISCLOSER AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES – 49 CFR PART 391.23 DOT DRUG & ALCOHOL TESTING; and Part II – CONSUMER REPORT AND INVESTIGATIVE CONSUMER REPORT DISCLOSURE (FOR EMPLOYMENT PURPOSES); (iii) prior to signing, I was given an opportunity to ask questions and to have those questions answered to my satisfaction; (iv) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention, or other lawful purpose; (v) I understand I may review this document with legal counsel prior to signing; (vi) I authorize USIS and any person or entity contacted by USIS to furnish the above-mentioned information; and (vii) facsimile or photographic copies of the authorization are as valid as an original. I hereby authorize Prospective Employer and its employees to obtain a PSP report of my crash and inspection history-CSA. The Applicant has released all liability of you and your company and all information will be held in strict confidence.Print Applicant Name (Digital Signature)(Required) Date/Time(Required) Hours : Minutes AM PM PhoneThis field is for validation purposes and should be left unchanged.
