Contact Information

Full Name	SS Number
Age	DOB (mm/dd/yyyy)
Address	City
State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip
Telephone	E-Mail Address (a response to this application will come to this email address, so be sure you check your email)
Best Time To Be Reached

Driving Experience

Occupation	Recent Experience	Years Experience	Endorsements
Owner Operator	Seattle & Tacoma Container Terminals		Haz-Mat
Professional Driver	Van		Doubles/Triples
Recent Graduate	Flatbed
Student	Heavy Haul
	Reefer

Class A CDL #	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Expiration Date (mm/dd/yyyy)
OTR Driving Experience less than 3 months 3-5 months 6-8 months 9-11 months 12-17 months 18-23 months 2 years 3 years 4 years 5-10 years more than 10 years	Local Driving Experience less than 3 months 3-5 months 6-8 months 9-11 months 12-17 months 18-23 months 2 years 3 years 4 years 5-10 years more than 10 years	Verifiable OTR Miles in Past 6 Months

Number of Accidents:	Number of Moving Violations:
Last Year	Last Year
Last Three Years	Last Three Years
Last Five Years	Last Five Years

Has Your License Ever Been Revoked or Suspended?   Yes  No

Have You Ever Been Cited for DUI or DWI?   Yes   No      If yes, how long ago (years)?

Have You Ever Been Convicted of a Felony?   Yes   No

Have you ever tested positive in a drug or alcohol test given in accordance with federal regulations? Yes  No

Have you ever refused to take a drug or alcohol test given in accordance with federal regulations? Yes  No

 

Present Employer

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Important!

Federal regulations require disclosure of all employment as driver of a commercial vehicle for the previous ten years.

Previous Employer 1

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 2

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 3

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 4

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 5

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 6

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 7

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

Previous Employer 8

Company		Address
City	State AL  AK  AZ  AR  CA  CO  CT  DE  DC  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  ME  MD  MA  MI  MN  MS  MO  MT  NE  NV  NH  NJ  NM  NY  NC  ND  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY	Zip		Telephone
Date From (mm/dd/yyyy)		Date To (mm/dd/yyyy)	Class A CMV Driver? (y/n)
Supervisor		Type of Trailer
Were you subject to the FMCSR’s while employed? Yes   No
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? Yes   No
Reason for Leaving

 

Additional Information

Additional information you feel is necessary to help process your application

Can Former Employers be contacted?  Yes  No

Can You Begin Working Immediately?  Yes  No     If Not, State When (mm/dd/yyyy)

Are You Willing to Relocate?  Yes  No          We are based in Seattle, Washington.

By submitting this application electronically, I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Graham Trucking Inc. 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. In connection with my application for employment, I understand that consumer reports which may contain public record information may be requested from DAC Services. I understand that the completion of this form does not assure me of a position Graham Trucking Inc. or obligate Graham Trucking Inc. in any way.  I have completed this application of my own free will and hold Graham Trucking Inc. harmless of all liability for providing this application for my use.

  

Don't have time to fill out our application?
Print our application, fill it out and fax to: 206-763-3738

Or mail it to:
Graham Trucking Inc.
722 South Chicago Street
Seattle, WA 98108

Thank you for your interest.  A representative will contact you soon.