| Have you attended Truck Driving School? |
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| If yes, give last school attended? (Name, Year, City, State) |
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| Do you have a commercial drivers license? |
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List all current & past drivers licenses: (License #, State, Expiration Date,
and class) |
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| Have your license ever been suspended or revoked? |
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| If yes, please list why, date, city and state. |
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| Have you ever been charged with a DUI? |
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| If yes, date, city and state. |
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| Alcohol & Substance Testing |
| Have you tested positive for a controlled substance within the last 3 years? |
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| Have you refused a drug or alcohol test within the last 3 years? |
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| Have you had an alcohol test with B.A.C. of 4.0 or higher within the last 3 years? |
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| If yes to any of these questions, please give the substance abuse professionals name? |
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| Address: (Street, City, State, Zip) |
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| Phone: |
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| Give a complete list of traffic violations(other than parking violations) for which you have been convicted or forfeited bond or collateral during the past five years. Failure to list all traffic violations within the past five years may result in your disqualification. |
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