East-West Express | Employment Application

First Name*:	This field is required.
Last Name*:	This field is required.
Middle Initial:
Home Address*:	This field is required.
Home City*:	This field is required.
State*:	This field is required.

Zip Code*:	This field is required.
Email Address*:	This field is required.
Home Phone*:	This field is required.
Cell Phone:
Pager Phone
Date of Birth:

Are you a US citizen?

Yes

Do you have the legal right to work in the USA?

Yes

Social Security No.:
CDL No.:
State:

CDL Expire Date:
CDL Issue Date:
Years of Driving Experience:

Has your CDL ever been revoked?

Yes

If yes, please explain:

Number of tickets in the last 3 years:

Please explain:

Have you ever been convicted of a felony?

Yes

If yes, please explain:

Number of accidents in the last 3 years:

Please explain:

Please read the following and press "Submit" only if you agree.

I certify that I personally completed this application for the purpose of employment and that all the information herein is true and correct. I understand that the information in this form will be used and that prior employers will be contacted for purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations, and that a complete background investigation will be done in accordance with with federal and state laws.

We desire to help you achieve the balance necessary for an effective life. Here at East-West Express, we realize that you have a work life AND a personal life, and we help you to attain enjoyment in both. When you join the East-West family, you join a firm that realizes you are a whole person, and treats you as the “whole you” wants to be treated.

© 2011 East-West Express, Inc. Atlanta Web Design by FirmDesign.
East-West Express PO Box 755 Villa Rica, GA 30180
Phone: 800.847.9556 | Fax: 678.941.1284