• Step 1
  • Step 2
  • Step 3

General Information

Last Name

First Name

Middle Name

Date of Application

Present Address

City

County

State

Date

Email Address

If hired, can you present evidence of your legal right to work in the US?

Social Security #

Telephone Number and Area Code

Name Used

City

County

State

From/To

Name Used

City

County

State

From/To

Street

City

County

State

From

To

Street

City

County

State

From

To

Street

City

County

State

From

To

Have you ever been fined or asked to resign by an employer?

If Yes, explain

What position are you applying for?

Minimum salary/wage requirement

How were you referred to our Company?

If Employee Referral or Other, please give details

Have you ever worked for ATN?

Where

When

Have you ever applied to ATN?

Where

When

If hired, what date are you available to start work?

Are you applying for:

Previous Military Service

Able to work

Educational Background

Name and city/state of High School and/or GED

Highest Grade Completed

Did you graduate?

Name and city/state of College or University

Highest Grade Completed

Did you graduate?

What was your degree and major?

Name and city/state of Trade, Business or Grad School

Did you graduate?

What was your degree/certificate?

List any other training or educational programs of note, including any certifications earned

Employment History

Employer Name

From

To

Beginning Salary

Ending Salary

Employer Address

Employer Phone #

Supervisor's Name and Title

Position(s) Held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact this employer?

Reason for leaving

Was this position covered under the Department of Transportation's regulations (DOT)?

Employer name

From

To

Beginning Salary

Ending Salary

Employer Address

Employer Phone #

Supervisor's Name and Title

Position(s) Held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact this employer?

Reason for leaving

Was this position covered under the Department of Transportation's regulations (DOT)?

Employer Name

From

To

Beginning Salary

Ending Salary

Employer Address

Employer Phone #

Supervisor's Name and Title

Position(s) Held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact this employer?

Reason for leaving

Was this position covered under the Department of Transportation's regulations (DOT)?

Employer Name

From

To

Beginning Salary

Ending Salary

Employer Address

Employer Phone #

Supervisor's Name and Title

Position(s) Held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact this employer?

Reason for leaving

Was this position covered under the Department of Transportation's regulations (DOT)?

Employment Gaps

From

To

Reason

From

To

Reason

From

To

Reason

From

To

Reason

License Information

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

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

Have you ever been disqualified subject to Part 391 of the Federal Motor Carrier Safety Regulation?

If 'Yes', please give details

How many years of driving experience do you have?

State

License #

Type

Expiration Date

Have you been licensed in another state in the last 3 years?

State

License #

Type

Expiration Date

Driving Experience

Class of Equipment

From

To

Approximate total number of miles

Class of Equipment

From

To

Approximate total number of miles

Class of Equipment

From

To

Approximate total number of miles

Class of Equipment

From

To

Approximate total number of miles

List all states where you have held a CDL in the last five years

List special driving courses or training you have received

Have you had experience supervising children or vulnerable adults? Explain

Have you ever driven a bus?

If yes, for what company or school district?

Dates

Salary / pay rate

I have had no accidents, driving convictions/citations or pending moving violations in the past 3 years.

Accident Review for past 3 years

Date

Nature of Accident (head-on, rear-end, upset, etc)

Fatalities

Injuries (other than yourself)

Date

Nature of Accident (head-on, rear-end, upset, etc)

Fatalities

Injuries (other than yourself)

Date

Nature of Accident (head-on, rear-end, upset, etc)

Fatalities

Injuries (other than yourself)

Traffic Citations / Convictions & Forfeitures during the past 3 years (other than parking violations)

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Impaired driving convictions - driving under the influence (DUI) / driving while intoxicated (DWI)

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Technician / Mechanic applicants only

Engine Tune-Up: Diesel

Engine Tune-Up: Gas

Electrical Systems

Clutch & Transmission - Truck

Inspection License Class

Air Brakes/Steering

Brakes/Steering

Lubrication

Tire Repair

Do you own your own shop tools?

List your current ASEs

Describe your diagnostic experience

List any other skills which are relevant for the position you seek

Declaration

Applicant's Name

Date

Print name