Apply Online

If you are interested in becoming a member of the TriState team please take a moment and send us a online application. Our staff will review your application and get in touch with you as soon as possible.
 

 

Name of Recruiter:

 

Personal Information

 

First Name:

Middle Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Country:
Home Number:
Cell Number:
Email Address:
Date of Birth: (m/d/yyyy)

Social Security #
Address For Past Three Years

Street:  

City:  

State:  

Zip:  

Country:  

Number of Years:  

Street:  

City:  

State:  

Zip:  

Country:  

Number of Years:  
 
Emergency Contact
 

Name:  

Phone:  

Are you a US citizen?
Yes    No

If not a US citizen, do you have a Permanent Resident card?
Yes    No

 

  

Driver License #:

Driver License State:

Driver License Issue Date:

Driver License Exp:

Do you have a CDL?

Haz-Mat Endorsement?

 Yes    No

Have you ever failed a drug test?

 Yes    No

Has your driver's license ever been suspended for any reason?

 Yes    No

Ever have any criminal convictions?

 Yes    No

If Yes, please provide full details:

Have you had any other Driver's licenses besides your current one above in the last 3 years?

Yes    No

List all Driver's licenses besides above you have held in the last 3 years. 
Please list states and driver's license numbers.

Your Status:

If driving for a truck owner, Please specify the following:

Truck Owner Name:

Truck Number:

Truck Type:

Truck Year:

 (yyyy)

Truck Model
Number of moving violations in the last 3 years:
Number of accidents in the last 3 years:
Employment History (List all employment for past 10 years)

Present Employer:

  

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:
If you were a driver, please provide the following information:

Equipment:

 Straight Truck 
Semi
Other

If Other, Please specify:

If Tractor, Please specify trailer size:

Previous Employment:

  
   

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:
   
   

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:
   
   

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:
   
   

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:
   
   

Employer Name:

Dates Employed:

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:
Please include street ,city ,state, and zip code.

Employer's Phone:

Position Held:

Reason for Leaving:

Employer Name:  

Dates Employed:  

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:  
Please include street, city,   state, and zip code.  

Employer's Phone:  

Position Held:  

Reason for Leaving:  
 
 

Employer Name:  

Dates Employed:  

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:  
Please include street, city,   state, and zip code.  

Employer's Phone:  

Position Held:  

Reason for Leaving:  
 
 

Employer Name:  

Dates Employed:  

 From: (m/d/yyyy)
     To:(m/d/yyyy)

Employer's Address:  
Please include street, city,   state, and zip code.  

Employer's Phone:  

Position Held:  

Reason for Leaving:  
If you were ever a driver, please provide the following information:

Equipment:

 Straight Truck 
Semi
Other

If Other, Please specify:

If Tractor, Please specify trailer size:
 
Statement of Understanding
I certify that I personally completed this application and that all of the information is true and correct. I authorize TriState  Expedited Services Inc to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officer or their agent, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by TriState  Expedited Services Inc and hold them harmless of all liability from release of said information.

Background Reports from the PSP Online Service

1. In connection with your application for employment with T.S. Expediting Services, Inc.  (“Prospective Employer”), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

2. I authorize Prospective Employer to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.


 I have read and understand the above statements and acknowledge by affixing my digital signature below.
 

I have read and understand the above statements:
Yes    No

Your Full Name:

 

   

 
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