Employment Application

Name   
Address   
City   
State  
Telephone   
Email   
Fax   
License No  
License State   
Comments   
Violations   
Experience   
App References   
 
 
Benefits
Bonuses 

DOT Inspections With No Violations $25.00

 
Disability Income Benefits 

60% of Average Daily Salary 180 Days of Benefits No Lifetime Maximum

 
Life Insurance 

$10,000 Benefit $40,000 Accidental Death

 
Medical 

$20 Office Visit Co-Pay Prescription Drug Benefit Nationwide Coverage

 
Retirement - 401K  Reduce Taxable Income Personal Savings / Retirement Fund Savings Grow Tax Deferred 
Vision Care 

No Deductibles No Waiting Periods Includes Eye Exams, Contact Lenses, Glasses and More

 
Wages  Single up to $0.40 per mile 1st Seat up to $0.195 per mile 2nd Seat up to $0.195 per mile