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5002 Cundiff Ct, Decatur, IL 62526
Phone: 866-379-8377        Fax: 217-875-5369

Application for Employment

All fields marked with a * are required:
Name *
Address *
Date of Birth *
SSN: (*)
Phone *
Cellphone:
Email:

 
 
Addresses
For Past
3 Years
 
 
Driver
License(s) *
State
License No.
Type
Expiration Date

Driving Experience
Class of Equipment
Type of Equipment
(Van, Tank, Flat, Etc)
Date(s) From
Date(s) To
Appox. No. of
miles (total)
Straight Truck
Tractor & Semi-Trailer
Other

Accident Record for Past 3 Years (Attach sheet if more space is needed)

Dates
Nature of Accident
(Head-on, Rear-end, Upset, Etc.)
Fatalities
Injuries
Last Accident
Next Previous
Next Previous

Traffic Convictions and Foreitures for the Past 3 Years
Other than Parking Violations - Attach sheet if more space is needed.)

Location
Date
Charge
Penalty
 
* Have you ever been convicted of a Felony, DIU, or DWI ? Yes No
* Has any license, permit, or privilege ever been suspended or revoked ?
If yes, please explain:
* Have you ever tested positive for drugs and/or alcohol ?
If yes, please explain:
* Are you under contract to another employer ?
If yes, please explain:

Past Employment Record

Please list ALL past employment for the last three years and ALL DOT regulated past employers for the past 10 years
Name:
Address: City: State:
Phone Number: Fax Number:
Position Held: From: To: 
Reason for leaving:  Was employer regulated by USDOT?  
Name: 
Address:  City:  State: 
Phone Number:  Fax Number: 
Position Held:  From:  To: 
Reason for leaving:  Was employer regulated by USDOT?  
Name: 
Address:  City:  State: 
Phone Number:  Fax Number: 
Position Held:  From:  To: 
Reason for leaving:  Was employer regulated by USDOT?  
Name: 
Address:  City:  State: 
Phone Number:  Fax Number: 
Position Held:  From:  To: 
Reason or leaving:  Was employer regulated by USDOT?  
Please use Additional Comments section if you need for more entrees.

Additional Comments
Please use this area for any additonal employment history or comments you would like to add to this application.
TO BE READ AND SIGNED BY THE APPLICANT
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.



* Applicant's Name: 
* Date:

Draw your signature, both First and Last Name (Hold down left mouse button to start drawing.)

By submitting this application I authorize McLeod Express LLC to verify my previous employment, check my Motor Vehicle Record, and process HireRight/USIS/DAC reports.

Driver Pre-Employment Notice: Click Here