Please enable JavaScript in your browser to complete this form. - Step 1 of 6General Information Please complete the form below.What position are you applying for? *Please SelectSoutheast RegionalFlorida OnlyLocal (Jacksonville, FL)Full Name *FirstLastEmail *PhoneAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHave you been at this address for 3 or more years? *Please Select Yes or NoYesNoPrevious Addresses Date of Birth *Social Security NumberHave you ever been known by any other name? *Yes or No?YesNoPlease List Name(s)If hired, can you furnish proof you are eligible to work in the United States? *Please SelectYesNoAre you at least 23 years of age or older?Please SelectYesNoHave you held a VALID US license for the past 36 months? *Please SelectYesNoLicense Class *Please SelectClass-AClass-BThird ChoiceDrivers License Number *State of Issue *Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense Expiration Date *Expiration Date of DOT Physical CardNextCDL Information Please complete the form below.CDL Endorsements *NoneTankerDoubles/TriplesHazmatX EndorsementTWICHazmat ExpirationTWIC Expiration DatePlease list any licenses held in other states for the previous 5 years, include license numbers if you can.Have you been to truck driving school? *Please SelectYesNoSchool NameSchool PhoneSchool AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeGPA if availableNextCurrent/Previous Employer Please complete the form below. Start Date *Ending Date *Employer Name *Employer AddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateEmployer Phone *Position Held *Reason for Leaving *Is this your current employer? *Please SelectYesNoMay we contact this employer at this time? *Please SelectYesNoWas this a driving position? *Please SelectYesNoType of Truck(s) *Day CabConventional SleeperStraight TruckBox TruckDump TruckMixerType of Trailer(s) *VanFlatbedRefferTankerRGN LowboyTrailer Length(s) *24' - 38'38 - 44'45 - 53'NextPrevious Employer Please list current or most recent first. Start Date #2Ending Date #2Employer Name #2Employer Address #2Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateEmployer Phone #2Position Held #2Reason for Leaving #2May we contact this employer at this time? #2Please SelectYesNoWas this a driving position? #2Please SelectYesNoType of Truck(s) #2Day CabConventional SleeperStraight TruckBox TruckDump TruckMixerType of Trailer(s) #2VanFlatbedRefferTankerRGN LowboyTrailer Length(s) #224' - 38'38 - 44'45 - 53'NextAdditional Information Please answer the following questions.Have you had any moving violations in the last 5 years? *Please SelectYesNoPlease list City, County and State, month, year and nature of offense and any fines involved. Please list miles over limit for speeding.Has your license ever been suspended? *Please SelectYesNoPlease give date and length of supension. List reason why, city, county and state.Have you had any accidents in the last 5 years? *Please SelectYesNoPlease give date, explaination, city, county and state and if you received ticket/fine (amount).Have you ever had a DUI, DWI, or OVI? *Please SelectYesNoPlease list date of offense, jail time, fine and or suspension time. We must have complete information to satisfy isusance carrier requirements. Have you ever been convicted of a felony? *Please SelectYesNoPlease give date and nature of offense, city, county, state and any fines and time served Please list EVERYTHING asked for per isurance requirements.Have you ever been convicted of a misdemeanor? *Please SelectYesNoPlease list date and nature of offense, city, county and state. also jail time, probation, or fines Please list EVERYTHING asked for.NextReferences References: Please list name, address, phone and years known.Reference Name Reference PhoneReference Address Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAgree to Information Request *I grant Atlantic Truck Lines permission to request any and all personal information from my previous employers, to access DAC, and to search by any other reasonable means to verify my background. I certify this information to be true and correct.Agree to Employer Check *I agree Previous Employer CheckSignature * Clear Signature PhoneSubmit