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 JavaFILE
Owner Operators Only Please
Personal Information
Last Name:
First Name:
MI:
Home Address:
Home City:
Home State:
Zip:
Date of Birth:
Day:
Year:
SSN:
Home Phone:
Email Address:
CDL Number:
State:
Issue Date:
Expiration Date:
Has your CDL ever been revoked:
Years of driving experience:
Number of tickets in last 3 years:
Number of accidents in last 3 years:
Number of licenses held in last 3 years:
Endorsements:
Current Employer:
From:
To:
Address:
Ctiy:
State:
Zip:
Phone:
Number of States:
Position Held:
Reason for leaving:
Last Employer:
From:
To:
Address:
Ctiy:
State:
Zip:
Phone:
Number of States:
Position Held:
Reason for leaving:
Last Employer:
From:
To:
Address:
City:
State:
Zip:
Phone:
Number of States:
Position Held:
Reason for leaving:

I authorize Genesis Trucking Inc., to do a complete background investigation in accordance with federal and state laws.  I authorize release of any information, including all information related to my alcohol and controlled substances testing and consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc., deemed necessary by Genesis Trucking Inc. in consideration of my employment.:

Genesis Trucking Inc.

1407 19 1/2 St S

Moorhead, MN 56560

Phone: 218-477-1111

Fax: 218-233-7829
Written by Silver Moon Computers.
Copyright © 2003 Genesis Trucking Inc. All rights reserved.
Revised: 01/03/04.