Wittig Transport, Inc. Online Driver Information

All fields marked with * are required

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

 Social Security Number: *  Date of Birth:  *mm/dd/yy

CDL Driver's License #:  * State:  *

Address:   *

City:  *   State:  *  Zip:  *

Home phone:  *   Other phone:  *

Email Address:

Miscellaneous Information

Years of Experience:          Any Tanker Experience:  Yes  No

Hazardous Materials Endorsement:  Yes  No

Have you ever been convicted of a crime?  Yes  No

If yes, explain: 

Was your license ever suspended/revoked?  Yes  No

When?        Where? 

Number of moving violations in the last 3 years: 

Any accidents in the last 3 years?  Yes  No           When?  mm/dd/yy

Who was at fault?                   Damage Amount? 

Type of equipment operated and number of years each:

Van:      Tanker:     Flatbed:       Other:

Reference Name:     Phone Number: 

Current Employer Information

Current Employer:      Position: 

Dates of Employment:      From:    To:     Pay:

City:     State: 

Reason for Leaving: 

Phone #:       Contact: 

Past Employer (1) Information

Past Employer:        Position: 

Dates of Employment:      From:    To:     Pay:

City:     State: 

Reason for Leaving: 

Phone #:       Contact: 

Past Employer (2) Information

Past Employer:        Position: 

Dates of Employment:      From:    To:     Pay:

City:     State: 

Reason for Leaving: 

Phone #:       Contact: 

I certify that I personally completed this application and that all of the information is true and correct. I authorize WITTIG TRANSPORT, 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 WITTIG TRANSPORT, 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 WITTIG TRANSPORT, INC. by whatever means is most expedient.