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Driver Application Appliction
  1. Position(s) Applied for:
    Invalid Input
  2. First Name
    Please enter your first name.
  3. Middle Name
    Please enter your middle name.
  4. Last Name
    Please enter your last name.

  5. List Your Addresses of Residency for the Past 3 Years.
  6. Current Address
    Please enter your address.
  7. City, State and Zip
    Please enter your City, State and Zip
  8. Previous Address 1
  9. City, State and Zip
  10. Previous Address 2
  11. City, State and Zip

  12. Email
  13. Telephone(*)
    Please enter your telephone number.
  14. Cell Phone
    Please enter your cell phone.
  15. Date of Birth(*)
    Please enter your date of birth
  16. Can you provide proof of age?

    Invalid Input
  17. SSN(*)
    Please enter your social security number.

  18. Have you worked for this company before?

  19. If so, where?
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  20. From what date:
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  21. To what date:
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  22. Rate of Pay?
    Invalid Input
  23. Position Held?
    Invalid Input
  24. Reason for leaving?
    Invalid Input

  25. Are you now employed?
    Invalid Input
  26. If not, how long since leaving the last employment?

    Invalid Input
  27. How did you learn of our job opportunity?

    Invalid Input
  28. Have you ever been convicted of a Felony?
    Have you ever been convicted of a Felony?
  29. If yes, for what?
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  30. Is there any reason you might be unable to perform the functions of the job for which you have applied?

  31. If you answer yes, which requirements are you unable to meet?

    Invalid Input

  32. Employment History

    All driver applicants to drive in interstate/intrastate commerce must provide
    the following information on all employers during the preceding 10 years.
    List complete mailing address, street numbers, cities, states, and zip codes.
    (NOTE: List employers in reverse order starting with the most recent)

    Please do not leave a gap in your employment history.

  33. Employer

  34. Employer's Name
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  35. May we contact them?

    Invalid Input
  36. Start Date of Employment
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  37. End Date of   Employment
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  38. Telephone
    Invalid Input
  39. Address
    Invalid Input
  40. City, State and Zip
    Invalid Input
  41. Contact Person
    Invalid Input
  42. Position Held
    Invalid Input
  43. Reason for leaving?
    Invalid Input
  44. Salary/Wage
    Invalid Input
  45. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  46. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  47. .

  48. Employer

  49. Employer's Name
    Invalid Input
  50. May we contact them?

    Invalid Input
  51. Start Date of Employment
    Invalid Input
  52. End Date of   Employment
    Invalid Input
  53. Telephone
    Invalid Input
  54. Address
    Invalid Input
  55. City, State and Zip
    Invalid Input
  56. Contact Person
    Invalid Input
  57. Position Held
    Invalid Input
  58. Reason for leaving?
    Invalid Input
  59. Salary/Wage
    Invalid Input
  60. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  61. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  62. .

  63. Employer

  64. Employer's Name
    Invalid Input
  65. May we contact them?

    Invalid Input
  66. Start Date of Employment
    Invalid Input
  67. End Date of   Employment
    Invalid Input
  68. Telephone
    Invalid Input
  69. Address
    Invalid Input
  70. City, State and Zip
    Invalid Input
  71. Contact Person
    Invalid Input
  72. Position Held
    Invalid Input
  73. Reason for leaving?
    Invalid Input
  74. Salary/Wage
    Invalid Input
  75. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  76. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  77. .

  78. Employer

  79. Employer's Name
    Invalid Input
  80. May we contact them?

    Invalid Input
  81. Start Date of Employment
    Invalid Input
  82. End Date of   Employment
    Invalid Input
  83. Telephone
    Invalid Input
  84. Address
    Invalid Input
  85. City, State and Zip
    Invalid Input
  86. Contact Person
    Invalid Input
  87. Position Held
    Invalid Input
  88. Reason for leaving?
    Invalid Input
  89. Salary/Wage
    Invalid Input
  90. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  91. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  92. Employer

  93. Employer's Name
    Invalid Input
  94. May we contact them?

    Invalid Input
  95. Start Date of Employment
    Invalid Input
  96. End Date of   Employment
    Invalid Input
  97. Telephone
    Invalid Input
  98. Address
    Invalid Input
  99. City, State and Zip
    Invalid Input
  100. Contact Person
    Invalid Input
  101. Position Held
    Invalid Input
  102. Reason for leaving?
    Invalid Input
  103. Salary/Wage
    Invalid Input
  104. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  105. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  106. .

  107. Employer

  108. Employer's Name
    Invalid Input
  109. May we contact them?

    Invalid Input
  110. Start Date of Employment
    Invalid Input
  111. End Date of   Employment
    Invalid Input
  112. Telephone
    Invalid Input
  113. Address
    Invalid Input
  114. City, State and Zip
    Invalid Input
  115. Contact Person
    Invalid Input
  116. Position Held
    Invalid Input
  117. Reason for leaving?
    Invalid Input
  118. Salary/Wage
    Invalid Input
  119. Were you subject to the Federal Motor Carrier Safety Regulations while employed?

    Invalid Input
  120. Was your job designated as a safety sensitive function in any DOT - regulated mode, subject to the Drug and alcohol testing requirements fo 49 CFR Part 40?

    Invalid Input
  121. .

  122. The Federal Motor Carrier Safety Regulations (FMCSR) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle (1) weighs or has a GVWR of 10,001 pounds or more (2) is designed or used to transport 9 or more passengers, or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

  123. Experience and Qualifications – Driver

  124. List Your Driver Licenses

  125. Type
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  126. License #
    Invalid Input
  127. State
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  128. Expiration Date
    Invalid Input

  129. Type
    Invalid Input
  130. License #
    Invalid Input
  131. State
    Invalid Input
  132. Expiration Date
    Invalid Input

  133. Type
    Invalid Input
  134. License #
    Invalid Input
  135. State
    Invalid Input
  136. Expiration Date
    Invalid Input

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

    Invalid Input
  138. Has any license, permit, or privilege ever been suspended or revoked?

    Invalid Input
  139. Driving Experience


  140. Do you have driving experience?

    Invalid Input
  141. Straight Truck
    Invalid Input
  142. Type of Equipment?
    (Van, Tank, Flat, Etc)
    Invalid Input
  143. Dates
    (From/To)
    Invalid Input
  144. Approximate Miles?
    (Total)
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  145. Tractor and Semi-Trailer
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  146. Type of Equipment?
    (Van, Tank, Flat, Etc)
    Invalid Input
  147. Dates
    (From/To)
    Invalid Input
  148. Approximate Miles?
    (Total)
    Invalid Input

  149. Tractor - Two Trailers
    Invalid Input
  150. Type of Equipment?
    (Van, Tank, Flat, Etc)
    Invalid Input
  151. Dates
    (From/To)
    Invalid Input
  152. Approximate Miles?
    (Total)
    Invalid Input

  153. Motor Coach / School Bus
    Invalid Input
  154. Type of Equipment?
    (Van, Tank, Flat, Etc)
    Invalid Input
  155. Dates
    (From/To)
    Invalid Input
  156. Approximate Miles?
    (Total)
    Invalid Input

  157. Other
    Invalid Input
  158. Type of Equipment?
    (Van, Tank, Flat, Etc)
    Invalid Input
  159. Dates
    (From/To)
    Invalid Input
  160. Approximate Miles?
    (Total)
    Invalid Input

  161. List States Operated in for Last Five Years:
    Invalid Input
  162. Show Special Courses or Training that Will Help you as a Driver:
    Invalid Input
  163. Which Safe Driving Awards Do You Hold and From Whom?
    Invalid Input
  164. Show Any Trucking, Transportation or Other Experience that may help in Your Work For This Company:
    Invalid Input
  165. List Courses and Training Other Than shown Elsewhere in This Application:
    Invalid Input
  166. List Special Equipment and Technical Materials You Can Work With (Other Than Those Already Shown):

    Invalid Input


  167. Accident Record for Past 3 Years or More

    Start with the latest account and go in reverse order.

  168. Date of Accident:

    Invalid Input
  169. Nature of Accident:
    (Head-On, Rear-End, Etc.)
    Invalid Input
  170. Fatalities?
    Invalid Input
  171. Injuries?
    Invalid Input

  172. Date of Accident:

    Invalid Input
  173. Nature of Accident:
    (Head-On, Rear-End, Etc.)
    Invalid Input
  174. Fatalities?
    Invalid Input
  175. Injuries?
    Invalid Input

  176. Date of Accident:

    Invalid Input
  177. Nature of Accident:
    (Head-On, Rear-End, Etc.)
    Invalid Input
  178. Fatalities?
    Invalid Input
  179. Injuries?
    Invalid Input


  180. Traffic Convictions and Forfeitures
    for the Past 3 Years

    (Other than parking violations)

  181. Location:
    Invalid Input
  182. Date of Conviction:

    Invalid Input
  183. Charge:
    Invalid Input
  184. Penalty:
    Invalid Input

  185. Location:
    Invalid Input
  186. Date of Conviction:

    Invalid Input
  187. Charge:
    Invalid Input
  188. Penalty:
    Invalid Input

  189. Location:
    Invalid Input
  190. Date of Conviction:

    Invalid Input
  191. Charge:
    Invalid Input
  192. Penalty:
    Invalid Input

  193. Location:
    Invalid Input
  194. Date of Conviction:

    Invalid Input
  195. Charge:
    Invalid Input
  196. Penalty:
    Invalid Input


  197. Education


  198. Enter Your Highest Grade Completed:
    Invalid Input
  199. Name, City and State of Last School Attended:

    Invalid Input

  200. To Be Read and Verified by 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. I authorize you to make such investigations and inquires of 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 even of my employment, I understand that false or misleading information given in my application or interview(s) may result in my discharge. I understand, also, that I am requested to abide by all rules and regulation of the Company.
  201. I have read and agree to the above statement.

    (*)
    Please enter check mark to submit application.

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Quality

Quality is the customers' perception of the value of our services. At Chaser, LLC we provide error-free, value-added care and service that meets and/or exceeds both the needs and legitimate expectations of those served.

 

Safety

From day one, safety has been the highest priority at Chaser, LLC. Safety for our employees, customers and motoring public will always remain our primary focus in all the policies, procedures and programs that govern our business.

 

Exceptional Service

As one of the industry’s most dynamic carrier, Chaser, LLC  continues to expand our diverse portfolio of specialty operations to meet your unique needs. We'll solve your unique transportation and needs whether regional or across the country.