Employment - Apply for a job

The age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age. I understand that the information in this application will be used to obtain driving records, employment records, and information regarding prior drug and alchol screens for purposes of investigation as required by the Federal Motor Carrier Safety Regulations.
Fill out the form below completely and click the submit button or download an application here, complete it and fax to 866-366-9305

Name:
Date of Birth:
Social Security #
Phone #:
Street Address:
City:
State:
Zip Code:
Email:
License #:
State:
Endorsements:

Tickets in the last 3 years?
Accidents in the last 3 years?
Are you 23 years or older?	yes no
Have you worked for this company before?
	yes no
Are you a US Citizen?	yes no
If no, do you have a legal right to live and work in the US?
	yes no
Have you ever tested positive or refused to test on any pre-employment Drug or Alchohol test?
	yes no

Current/Most Recent Employer
Name:
Phone Number:
How many states have you driven in?:
Are you presently employed?	yes no
May we call your current employer?	yes no
Address:
Position Held:
	from to
Why did you want to change employers?

Second Last Employer
Name:
Phone Number:
How many states have you driven in?:
Address:
Position Held:
	from to
Why did you quit?

Third Last Employer
Name:
Phone Number:
How many states have you driven in?:
Address:
Position Held:
	from to
Why did you quit?

Fourth Last Employer
Name:
Phone Number:
How many states have you driven in?:
Address:
Position Held:
	from to
Why did you quit?
By submitting this application, I signify that I give permission for Grand Island Express to order MVR, DAC Reports, and do Background Check.(Required)

to top

Your address is 216.120.230.85