On-Line Employment Application

 

  Enter Your Name
  Enter Your Address
  Enter Your City
  Enter Your State
  Enter Your Zip Code
  Social Security Number
  Home Telephone Number
Date of Birth
Month   Day   Year

Select Terminal Location that you are applying for:
Select Columbus, Indiana Springfield, Missouri Kingman, Arizona Amarillo, Texas

Enter Your Email Address:


Driving Information:
Years OTR Experience: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Months Driving: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 (Last three years)
CDL Number:
CDL State:

Driving Record:
Numbers of Accidents: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (Last three Years)

Moving Violations: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (Last three Years)

Valid Motor Vehicle License: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (Years)

Failed Drug Screen: Select 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1995 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 (Year)

D.U.I. Charge: Select Yes No

Reckless Driving Charge: Select 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1995 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 (Year)

License Suspended: Select 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1995 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 (Year)

Hazmat Endorsement: Select Yes No

Felony Convictions: Select Yes No

Please enter your last two driving jobs, Employer's name, Address and Dates of Employment:


The physical requirenents of the job include the ability to load/unload cargo up to and including lifting 50 LBS. from above your head to the floor and back above your head repeatedly, and squatting and bending while pulling trailer axle and 5th wheel pins.

Are you able to perform these acts? Select Yes No

NOTE: By submission of this for you authorize, without reservation, any part of agency contacted by CTI Trucking Inc. designated insurance representatives to furnish the above mentioned information.

Please type any and all comments that you feel that have not been covered here.


Please list the date that you are available for Employment: