First Name*
Last Name*
Email*
Phone*
Address*
How did you hear about Midwest Trucking?
Have you ever worked for Midwest Trucking or Diamond J Companies before?* YesNo
When?
Have you received a ticket in the last 3 years?* YesNo
Please Explain
Have you had an accident in the last 3 years?* YesNo
Have you had an OOS Violation in the last 3 years?* YesNo
Have you been convicted of a felony?* YesNo
Have you ever tested positive or refuse to test on any pre-employment drug or alcohol test?* YesNo
Do we have your permission to run your MVR?* YesNo
How many years of experience do you have?*
Who is your current / most recent employer?*
How long have you worked with your current/most recent employer?*
Type of trailer?*
Why are you leaving?
Who was your second to last employer?*
How long did you work for your second to last employer?*
Why did you leave?
