Legacy Express Onboarding

Personal Information

First Name*

Last Name*

Current Address*

Address 2

City*

State/Province*

Zip*

Country*

Residence 3 years or longer? (if no, provide previous address below)

Yes No

Previous Address

Previous City

Previous State/Province

Previous Zip

Previous Country

SSN/SIN*

Date of Birth*

Primary Phone*

Cell Phone

Email*

Preferred Contact Method

Preferred Contact Time

I agree to receive information concerning future opportunities or promotions from Legacy Express Trucking, Inc by email or other commercial electronic communications.*

Yes No

Would you like to receive communication from Legacy Express Trucking, Inc via text message?*
By participating, you consent to receive text messages sent by an automatic telephone dialing system, which may contain recruiting/advertising messages. Consent to these terms is not a condition of being hired, contracted, or leased. You may opt out at any time by texting STOP to unsubscribe. You also agree thatLegacy Express Trucking, Inc's service provider receives in real time and logs your text messages withLegacy Express Trucking, Inc.

Yes No

General Information

What position are you applying for?*

Type of Equipment?*

What style of driving do you prefer?*

Are you legally eligible for employment in the United States?*

Yes No

Do you read, write, and speak English?*

Yes No

What date did your last employment end?

Have you ever worked for this company before?

Yes No

If yes, Enter start and end dates, location, position, and reason for leaving:

Do you have a current TWIC card?

Yes No

TWIC card expiration date

Please enter the names of any relatives employed here:

Have you ever been known by any other name?

Yes No

If yes, Enter previous name

How did you hear about us?

If driver referral, Enter driver's name

If other, Please explain:

Driver Training

Start Date*

End Date*
(If you are currently in school, please enter the current month and year as the End Date)

School Name*

Address

City

State / Province

Zip

Driving Experience

Equipment Type*

Start Date*

End Date*

Approximate Miles:

Licenses

License Number:*

License Authority:*

Country:*

License Class:*

License Expiration Date:*

DOT Medical Card Expiration Date:*

Current License?*

Commercial License?*

Endorsements:

Employment

Company Name:*

Start Date:*

End Date:

Street Address:*

Address 2:

City:*

State/Province:*

Zip:*

Country:*

Phone:*

Position Held:*

Reason For Leaving:

Were you terminated/discharged/laid off?*

Is this your current employer?*

May we contact this employer at this time?*

Did you operate a commercial motor vehicle?*

Were you subject to the Federal Motor Carrier or Transport Canada Safety Regulations while employed/contracted by this employer/contractor?*

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?*

Areas Driven:

Miles Driven Weekly:

Most Common Truck Driven:

Most Common Trailer:

Trailer Length:

FMCSR

Under FMCSR 391.15, are you currently disqualified from driving a commercial motor vehicle? [49 CFR 391.15]*

Yes No

Has your license, permit or privilege to drive ever been suspended or revoked for any reason? [49 CFR 391.21(b)(9)]*

Yes No

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?[49 CFR 391.21(b)(9)]*

Yes No

In the past three(3) years, have you ever been convicted of any of the following offenses: [49 CFR 391.15]:*

Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more.
Driving under the influence of alcohol, as prescribed by state law.
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations.
Driving a commercial motor vehicle under the influence of any 21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug.
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.1 1 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
Leaving the scene of an accident while operating a commercial motor vehicle.
Or any other felony involving the use of a commercial motor vehicle.

Yes No

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?*

Yes No

If yes, Please explain:

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 3 years?*

Yes No

If yes, Please explain:

Federal FCRA Summary of Rights Acknowledgment

Download Printable Version

By checking this box, I (a) acknowledge that I have read and understand the federal FCRA Summary of Rights and have been given the opportunity to copy/print the Summary of Rights and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

PSP Disclosure and Authorization

Download Printable Version

By checking the box, I (a) acknowledge that I have read and understand the PSP Disclosure and Authorization and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

FCRA Disclosure

Download Printable Version

By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

FCRA Authorization

Download Printable Version

By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

Employment Verification Acknowledgment and Release (DOT Drug and Alcohol)

Download Printable Version

By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

Clearinghouse Release

Download Printable Version

By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.*

Summary of Rights Under 15 U.S.C. Section 1681m(a)

Download Printable Version

By checking this box, I represent that I understand and agree to the above language.*

Investigative Consumer Report Disclosure

Download Printable Version

By checking this box, I represent that I understand and agree to the above language.*

Upload Resume

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Signature

Signature Date:*

Signature:*

Please Sign In The Box Above

Personal Information

General Information

Equipment (Owner/Operators Only)

Driver Training

Driving Experience

Licenses

Employment

FMCSR

Vehicle Accident Record

Traffic Convictions \ Violations

Federal FCRA Summary of Rights Acknowledgment

PSP Disclosure and Authorization

FCRA Disclosure

FCRA Authorization

Employment Verification Acknowledgment and Release (DOT Drug and Alcohol)

Clearinghouse Release

Summary of Rights Under 15 U.S.C. Section 1681m(a)

Investigative Consumer Report Disclosure

Upload Resume

Signature