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Super Service, Inc. Driver Application

(Fields marked with * are required for proper routing of your request)

Driver Information

* First Name:

* Last Name:

* Social Security Number:

* Address:

* City:

* Zip:

Email:

* Phone:

* Date of Birth:

Miscellaneous Information

* CDL Number:

* CDL Expiration:

* CDL State:

* Years of Experience:

Hazardous Materials Endorsements:

Yes
No

Have you ever been convicted of a crime:

Yes
No

* If Yes Explain:

* License ever suspended/revoked?:

Yes
No

If so when and where?:

* Moving violations in last 3 years:

Any accidents in last 3 years:

Yes
No

If so When?:

Current Employer Information

Current Employer:

Complete Address:

Phone:

From Date:

To Date:

Past Employer 1 Information:

Past Employer1:

Complete Address:

Phone:

From Date:

Space

To Date:

Space

I certify that I personally completed this application and that all of the information is true and correct. I authorize Super Service, Inc. to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Super Service, Inc. and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Super Service, Inc. by whatever means is most expedient.

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