Comtrak Initial Driver Application

On Line Initial Driver Application

First Name:
Last Name:
Address:
City:
State:
Zip:
Telephone:
E Mail:
SS#:
Drivers License #:
License State:
Birthdate (MM-DD-YY):
CDL?:	Yes No
HazMat Endorsement?:	Yes No
Referred By:
Experience:	Years Months

Has your license ever been suspended or revoked?	Yes No
Have you ever been convicted of a DUI?	Yes No
Has you ever been convicted of a Felony?	Yes No
Employment History

1.) Company Name:
Phone:
Employed From:		Employed To:
Position:

2.) Company Name:
Phone:
Employed From:		Employed To:
Position:

3.) Company Name:
Phone:
Employed From:		Employed To:
Position:

Upon submission, I certify that I personally completed this application for the purpose of employment and that all the information is true and correct. I authorize Comtrak Logistics, Inc. to do a complete background investigation in accordance with federal and state laws. I authorize release of any information by any former employers and hold them harmless of any liability from release of said information.