(580)310-1009 sandmanwes152003@yahoo.com

If you answered "yes" to the above question, explain

Has any license, permit or privilege ever been suspended or revoked? *

Yes

Previous Address 1 *

Driver License/Number *

Driving Experience *

Address *

Previous Address 3 *

Driver License/State *

Driver License/Type *

If you answered "other" to the above question, explain

Traffic Citations and Forfeitures for the Past 3 Years *

TO BE READ AND SIGNED BY APPLICANT 

I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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.

 In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. “I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: Review information provided by current/previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”

Have you ever been denied a license, permit or privilege to operate a motor vehicle? *

Yes

If you answered "yes" to the above question, explain *

Previous Address 2 *

Middle Name: *

625 N Main St Ada, OK 74820

Date *

Driver Application