Driver Application Form

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Your Last Name: *
Your First Name: *
Your Middle Initial:

Name that you use for your courier business:
(If applicable)
Street Address Line 1: *
Street Address Line 2:
City: *
State: *
ZIP Code: *
TELECOMMUNICATIONS: (Please include area codes)
Home Phone:
Nextel Phone: (If available)
Nextel Private ID#: (If available)
Cell Phone: *
Pager:
E-mail Address:
 BUSINESS INFORMATION:  
Social Security Number or Federal EIN: *
Operating Region: *
Type of Vehicle:  
Number of years of experience as a courier service driver:
Name of company you have most courier experience with:
Availability/ wk* : 35-60 hours per week    10-34 hours per week
Shift availability* : Weekdays Only Weeknights Only
  Weekends Weekdays and weeknights
  Weekdays, weeknights and weekends
Country of Citizenship: *
Highest level of education:
Have you ever been convicted of a felony?
How did you learn about us?
If you heard about us through a referral, please let us know the name of the person who referred us to you:
BUSINESS REFERENCES:
Please provide us with commercial business references that you have worked with. You should include companies that you have had an affiliation within the past 5 years:
Business Reference 1:
Name of Business:
Nature of Relationship:
Month and Year Affiliation Began:
Month and Year Affiliation Ended:
Name of Employer:
Phone Number: (Include area code)
Business Reference 2:
Name of Business:
Nature of Relationship:
Month and Year Affiliation Began:
Month and Year Affiliation Ended:
Name of Employer:
Phone Number: (Include area code)
Business Reference 3:
Name of Business:
Nature of Relationship:
Month and Year Affiliation Began:
Month and Year Affiliation Ended:
Name of Employer:
Phone Number: (Include area code)
*Fields are required
*Optional until requested by Golden Eagle Transportation, Inc. to continue hiring process.
ACKNOWLEDGEMENT AND AUTHORIZATION:
I ackNowledge that the information contained herein is correct to the best of my kNowledge and that any misrepresentation of material may be cause of termination of my contract, if hired. I am providing Golden Eagle Transportation, Inc. with authorization to check my references and background information.I give consent to call, write, or otherwise communicate with persons or companies listed above and to investigate using public or other sources as deemed necessary by Golden Eagle Transportation, Inc. to verify such information.

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