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Application
Hicks Trucking Company

Sales and Dispatch: 888-223-7633
Recruiting: 888-263-0320
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September 8, 2010
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Hicks Trucking Company
Driver Application Form

Fill In this Quick 3 Minute application!



Contact Information
First Name Middle Last
Address 1 Address 2
City State Zip
Day Phone Cell Phone Night Phone
E-mail Best Time to Call
SSN Date of Birth (mm/dd/yyyy)


CDL Information
Do You Have a CDL: Yes No


Issue State:

Driver Information
I am a: Company Driver Owner Operator

Experience
Trailer Experience Years
Flatbed
Stepdeck

Current Employer
Employer Name Address Phone
City State Zip
Start Date End Date
Position Held Reason Left Trailer

Previous Employer #1
Employer Name Address Phone
City State Zip
Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)
Position Held Reason Left Trailer

Previous Employer #2
Employer Name Address Phone
City State Zip
Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)
Position Held Reason Left Trailer

Previous Employer #3
Employer Name Address Phone
City State Zip
Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)
Position Held Reason Left Trailer

Tickets
Number of tickets received in the last 3 years:
Have you ever received a DUI/DWI? Yes No
Has your license ever been suspended or revoked?Yes No
Have you ever been denied a license? Yes No
Have you ever been convicted of a felony? Yes No

Owner Operator (Not an Owner Operator? Please skip this section)
Tractor Model
Do you own your tractor? Yes No
Year/Make

Driving History
Accidents
Number of accidents in the last 3 years
Number of preventable accidents in the last 3 years


TERMS AND CONDITIONS FOR HICKS TRUCKING COMPANY APPLICATION FOR CERTIFICATION
I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Hicks Trucking Company to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold Hicks Trucking Company harmless of all liability for providing this application for my use.

In connection with my application for certification (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the following type of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY HICKS TRUCKING COMPANY TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and I agree that such information which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services.

I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
To print a paper copy of this form click here


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