Central Transportation Services
Driver Application-Short Form
NOTE: This document does not automatically reply. It must be saved to your desktop, completed and either copied to your email account and sent to or printed and faxed to 316-682-3377.
Owner OperatorCompany Driver
First :Middle :Last : Social Security:Date of Birth:
Street : City : State : Zip :
Phone Number: Email Address:
Years OTR: Type Trailer:Dry Bulk PneumaticHopperFlatOther
Dry Bulk Verifiable Pneumatic Trailer Experience: NoneLess than 12 months Over 1 year
Current CDL License Class A: YesNo
License #: State: Expiration:
Have you ever been convicted of a crime? Yes No Date/Crime:
Have you ever been disqualified to drive by Federal Regulations? Yes No Date/Reason:
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes No Date/Reason:
Have you ever had any license permit or privilege suspended or revoked?
Yes No Date/Reason:
Have you ever been convicted for driving while under the influence of alcohol or drugs?
Yes No Date:
Traffic Violations in Last 3 years:None
Date/Violation:
Date/Violation:
Date/Violation:
Date/Violation:
Accidents in the past 3 years:None
Date/What happened?:
Date/What happened?:
Date/What happened?:
Date/What happened?:
Work History (past 3 years):
Company:
CityState:
Phone #:
Date Started: Ended:
Type of trailer pulled:
Reason for leaving:
Company:
CityState:
Phone #:
Date Started: Ended:
Type of trailer pulled:
Reason for leaving:
Company:
CityState:
Phone #:
Date Started: Ended:
Type of trailer pulled:
Reason for leaving:
Company:
CityState:
Phone #:
Date Started: Ended:
Type of trailer pulled:
Reason for leaving:
Electronic Release:
I certify that I personally completed this application and that all of the information is true and correct. I authorize Central Transportation Services, LLC. (CTS), and its agents or representatives the right to investigate all references and to secure additional information about my employment background, and information related to my controlled substance and alcohol testing and/or results pursuant to Regulation 49 CFR 391.23d & e. I further authorize CTS and its agents or representatives’ permission to receive consumer reports regarding my employment history, criminal background, and worker compensation claims from third party agencies such as HireRight or other agencies, which may be requested by CTS to provide such information. I hereby release from all liability for damages CTS and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information:
I agree with the above statement, please begin processing my application! I disagree, please contact me!
E-Signed: Date: